ECONOMIC DEVELOPMENT INITIATIVE (EDI) BUSINESS DIRECTORY INFO FORM
QUALIFICATIONS
1. Must be an active member of The House of Judah.
2. Must be a consistent tither at The House of Judah.
3. Must complete and submit a EDI Business Directory Form and agree to the User Agreement.
*Business will be notified via email on determination within 2 weeks of submission*.


This form is used to collect and keep current track of business' information for the EDI directory.
Email address *
TODAY'S DATE:
MM
/
DD
/
YYYY
FULL BUSINESS NAME:
D/B/A: (IF APPLICABLE)
BUSINESS ADDRESS:
BUSINESS EMAIL ADDRESS:
BUSINESS WEBSITE ADDRESS:
NATURE OF BUSINESS:
IS YOUR COMPANY INCORPORATED:
OWNER/PRINCIPAL OF BUSINESS:
PERSONAL TELEPHONE NUMBER FOR OWNER/PRINCIPAL:
NUMBER OF EMPLOYEES/ INDEPENDENT CONTRACTORS WORKING WITH YOUR COMPANY:
DOES THE WORK PERFORMED BY YOUR COMPANY REQUIRE A STATE LICENSE?
Clear selection
IF SO, DO YOU POSSESS SUCH (VALID) LICENSE:
Clear selection
PLEASE PROVIDE THE FOLLOWING: LICENSE NUMBER, ISSUANCE AND EXPIRATION DATE OF LICENCE:
DOES YOUR COMPANY MAINTAIN ANY INSURANCE POLICIES:
Clear selection
IF SO, WHAT TYPES OF INSURANCE POLICIES DO YOU MAINTAIN:
PLEASE PROVIDE THE INSURANCE COMPANY POLICY NUMBER AND EXPIRATION DATE:
HAS YOUR COMPANY EVER HAD ANY COMPLAINTS LODGED AGAINST IT:
Clear selection
IF SO, WHAT WERE THE NATURE OF THE COMPLAINTS:
WHEN WERE THE COMPLAINTS MADE AND WHAT WAS/IS THE OUTCOME:
ARE YOU IN COMPLIANCE WITH ALL FEDERAL, STATE AND LOCAL LAWS, RULES AND REGULATIONS RELATED TO YOUR TYPE OF BUSINESS:
Clear selection
IF NOT, PLEASE PROVIDE THE AREAS IN WHICH YOU ARE NOT IN COMPLIANCE AND THE EXPECTED DATE OF COMPLIANCE:
CHECK HERE IF YOU AGREE TO THE TERMS AND CONDITIONS STATED IN THE USER AGREEMENT.
DISCLAIMER:
THE INFORMATION PROVIDED ON THIS FORM IS FOR INFORMATIONAL PURPOSES ONLY. THE COMPLETION OF THIS FORM DOES NOT GUARANTEE PARTICIPATION IN THE THOJ BUSINESS DIRECTORY. YOUR CONSENT TO THE TERMS AND CONDITIONS OF THE THOJ USER AGREEMENT IS A CONDITION PRECEDENT. IN ADDITION, THOJ MUST APPROVE YOUR PARTICIPATION BEFORE YOUR INFORMATION CAN BE LISTED.
A copy of your responses will be emailed to the address you provided.
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