Business Background Information Request

Your cooperation is appreciated in helping BBB to provide accurate up-to-date information to your prospective customers, suppliers, financial institutions and others who inquire about your business.

This form will give us basic information about your business to enable us to create a BBB Reliability Report. This is not a BBB Accredited Business Application.

Our use of your personal information will be consistent with our BBB Privacy Policy.

(items in red below are required)

 
Business Name (please list in order best known to the public)
Business Name #1:
Business Name #2:
Business Name #3:
Business Name #4:
Business Name #5:
 

Business Address
Address:
City:
State:
Zip Code:
 

Mailing Address
Address:
City:
State:
Zip Code:
 
Public Phone:
Additional Public Phone:
Additional Public Phone:
Toll-Free Phone:
Private Phone: (for BBB internal use only)
Fax::
Web Address:
Web Address:
Web Address:
Public Email:
Sales Email:
Customer Service Email:
Technical Support Email:
 
 

Please list three executives/principals of the firm
Salutation:
Name:
Title:
E-mail:
Phone:
Fax:
 
Salutation:
Name:
Title:
E-mail:
Phone:
Fax:
 
Salutation:
Name:
Title:
E-mail:
Phone:
Fax:
 
Complaint Handler Salutation:
Complaint Handler Name:
Complaint Handler Title:
Complaint Handler E-mail :
Complaint Handler Phone:
Complaint Handler Fax:
Complaints should be: Mailed
Faxed
Emailed
   
 

Business Information

Number of employees:   
Established:   
Incorporated:   
Type of business entity: Corporation
Partnership
Sole Proprietorship
Franchisee
LTD
LLC
   
Number of Active Customers:
(BBB Internal Use Only)		 1-499
500-49,999
50,000-99,999
100,000-999,999
1,000,000-9,999,999
10,000,000-49,999,999
50,000,000 or more
   
Gross Annual Revenue:
(BBB Internal Use Only)		 $1-$999,999
$1,000,000-$19,999,999
$20,000,000-$99,999,999
$100,000,000-$999,999,999
$1,000,000,000-$9,999,999,999
$10,000,000,000-$49,999,999,999
$50,000,000,000 or more
   
Business Scope:
 Local 1 Location
Local Multiple Locations
Regional
National
International
Internet Only
   
Hours of Operation:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
   
Payment Methods Accepted:
(select all that apply by holding down the ctrl key)
   
Corporate Headquarters City:
Corporate Headquarters State:
   
Is company a franchise? Yes No
If yes, where is franchise headquartered?
   
  Click on entry box to select from Type of Business Listing   
Type of business:
Additional type of business #2:
Additional type of business #3:
Additional type of business #4:
Additional type of business #5:
Additional type of business #6:
   
  Brief factual description of products and/or services

 
 
Brands you sell
 
 
Products you sell
 
 
Additional public telephone number(s) at your primary location
 
   
 

Additional locations
Please list:
-address
-city
-state
-zip code
-phone
-fax
-and if at a mall the mall name.
 
   
  Licensing Information
Please list:
-license number
-type
-issuing agency
-state issued
-date issued
-expiration date
-Please specify if it is a personal or business license.
 
   
  Refund, Exchange and Return Policy:
 
   
Notes or Comments to BBB:
 

Submitted by

Your Name:
Your Title:

Reference # (if known):

 B
The reference number can be found at the bottom of the cover letter and starts with a B.
It can also be found on the back of the Business Background Information Request Form, in the gray area. (BBIR#)
 

Before submitting this form, please type the characters displayed above: