|
Field |
Description |
Required? |
|
Business Name |
The Doing Business As (DBA) name of you business, up to 25 characters in length. |
Yes |
|
Business Legal Name |
The legal name of your business, up to 32 characters in length. |
Yes |
|
Federal Tax ID |
The Federal Taxpayer ID assigned to your business. If you do not have a Federal Taxpayer ID, enter the social security number of the primary owner of your business. |
Yes |
|
Business Estb. Date |
The month and year your business was established. |
Yes |
|
Business Phone |
The area code and phone number for your business. |
Yes |
|
Business Fax |
The fax number for your business. |
No |
|
Business Address 1 |
The first line of your business street address. Cannot use a PO Box. |
Yes |
|
Business Address 2 |
The second line of your business street address. |
No |
|
City |
The city of your business street address. |
Yes |
|
State |
The state of your business street address. |
Yes |
|
ZIP/Postal Code |
The ZIP code of your business street address. |
Yes |
|
Field |
Description |
Required? |
|
First Name |
The first name of a person we can contact at your business if we have questions. |
Yes |
|
Last Name |
The last name of a person we can contact at your business if we have questions. |
Yes |
|
Phone |
The phone number of the contact person. |
Yes |
|
|
The email address of the contact person. |
Yes |
|
Mailing Address Name |
The name of the person to whom all correspondence can be sent. |
No |
|
Mailing Address 1 |
The first line of the business contact's mailing street address. |
No |
|
Mailing Address 2 |
The second line of the business contact's mailing street address. |
No |
|
Mailing City |
The city of the business contact's mailing street address. |
No |
|
Mailing State |
The state of the business contact's mailing street address. |
No |
|
ZIP/Postal Code |
The ZIP code of the business contact's mailing street address. |
No |
|
Field |
Description |
Required? |
|
Business Type |
Select the option that best describes your type of business. |
Yes |
|
Number of Years at Main Location |
The number of years your business has been located at the business address entered. |
Yes |
|
Industry Type |
Select the option that best describes the industry your business is in. |
Yes |
|
Description of Product/Service Sold |
Enter a brief summary of the products or services your business provides |
Yes |
|
Business URL |
The home page Web address for your business. |
Yes |
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