ECONOMIC DEVELOPMENT INITIATIVE (EDI) BUSINESS DIRECTORY INFO FORM
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:
Your answer
D/B/A: (IF APPLICABLE)
Your answer
BUSINESS ADDRESS:
Your answer
BUSINESS EMAIL ADDRESS:
Your answer
BUSINESS WEBSITE ADDRESS:
Your answer
NATURE OF BUSINESS:
Your answer
IS YOUR COMPANY INCORPORATED:
Your answer
OWNER/PRINCIPAL OF BUSINESS:
Your answer
PERSONAL TELEPHONE NUMBER FOR OWNER/PRINCIPAL:
Your answer
NUMBER OF EMPLOYEES/ INDEPENDENT CONTRACTORS WORKING WITH YOUR COMPANY:
Your answer
DOES THE WORK PERFORMED BY YOUR COMPANY REQUIRE A STATE LICENSE?
IF SO, DO YOU POSSESS SUCH (VALID) LICENSE:
PLEASE PROVIDE THE FOLLOWING: LICENSE NUMBER, ISSUANCE AND EXPIRATION DATE OF LICENCE:
Your answer
DOES YOUR COMPANY MAINTAIN ANY INSURANCE POLICIES:
IF SO, WHAT TYPES OF INSURANCE POLICIES DO YOU MAINTAIN:
Your answer
PLEASE PROVIDE THE INSURANCE COMPANY POLICY NUMBER AND EXPIRATION DATE:
Your answer
HAS YOUR COMPANY EVER HAD ANY COMPLAINTS LODGED AGAINST IT:
IF SO, WHAT WERE THE NATURE OF THE COMPLAINTS:
Your answer
WHEN WERE THE COMPLAINTS MADE AND WHAT WAS/IS THE OUTCOME:
Your answer
ARE YOU IN COMPLIANCE WITH ALL FEDERAL, STATE AND LOCAL LAWS, RULES AND REGULATIONS RELATED TO YOUR TYPE OF BUSINESS:
IF NOT, PLEASE PROVIDE THE AREAS IN WHICH YOU ARE NOT IN COMPLIANCE AND THE EXPECTED DATE OF COMPLIANCE:
Your answer
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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