Google Guaranteed/Screened Form

Google Guaranteed/Screened Pre-Registration Form

Get ahead of your competition by filling out the pre-registration form
SAFE/ENCRYPTED

With end-to-end encryption — the technique used by Jotform — data is encrypted on the sender's device and decrypted on the recipient's device, so no one – not even Jotform – has access to your form submissions.
Business Contact Person*

First NameLast Name
Email
example@example.com
Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Details
Business Industry
Business Name*
YesNo
YesNo, just one owner for all locations
List Each Owners Full Name, Location, And Email Address
For example: Bob Johnson, Downtown Location, BJohnson@business.com. Then press enter to enter the next owner.
Each owner will need a headshot submitted. Tap link below to upload headshots.

Tap To Upload Headshots
Each owner will need to submit a picture of their driver's license (front and back).

Tap to upload picture each driver's license
Upload Proof Of Insurance (General Liability Insurance) For Each Location

Tap To Upload Documents
Add Auto Body Shop License Number For Each Location
For Example: Location 1 name, License number
Owners Information

First NameLast Name
Owners Email Address
This must be the owners email address
Headshot of the owner

Upload a headshot of the owner
Cancelof
Driver's License Upload

Upload a picture of the owners driver's license (front and back)
Cancelof
Proof Of Insurance (General Liability Insurance)

GOOGLE SCREENED: Insurance requirements for a Google badgeUpload a PDF file to show proof of insurance. The file should contain current documents of general liability insurance for the practice.A certificate of insurance document must clearly show the amount of liability insurance and the expiration date, and the policy must satisfy the minimum insurance amount specified by occupation here: $250,000 for Auto Body Shop.
Cancelof
Auto Body Shop License Number (Motor Vehicle Repair License)
Google matches your license against the owner’s name or business name.
Storage
Business Name
YesNo
YesNo, same owner for all locations
List Each Owners Full Name, Location, And Email Address
For example: Bob Johnson, Downtown Location, BJohnson@business.com. Then press enter to enter the next owner.
Each owner will need a headshot submitted. Tap the link below to upload headshots.

Tap To Upload Headshots
Each owner will need to submit a picture of their driver's license (front and back).

Tap to upload a picture of each driver's license
Each location will need to upload the following licenses:
- General Liability Insurance
- Tap Here To Upload Documents
Owner Information

First NameLast Name
Owners Email
example@example.com
Headshot of owner

Storage Owner Headshot
Cancelof
Drivers License Picture

Take a picture of owners driver's license (front and back)
Cancelof
Proof Of General Liability Insurance

GOOGLE SCREENED: Insurance requirements for a Google badgeUpload a PDF file to show proof of insurance. The file should contain current documents of general liability insurance for the practice.A certificate of insurance document must clearly show the amount of liability insurance and the expiration date, and the policy must satisfy the minimum insurance amount specified by occupation here: $250,000 for Storage.
Cancelof
Dentists
Dental Practice Name
YesNo
YesNo
List Each Owners Full Name, Practice Location, And Email Address
For example: Bob Johnson, Downtown Location, BJohnson@business.com. Then press enter to enter the next owner.
List Each Owners: National Provider Indentifier (10 digit number), Dentist License number from your states dental commission
List Each Owners: Education (dental school), Degree, Year Graduated, Residency, Year Completed
Upload A Headshot Of Each Of The Owners (upload images at the same time)

Cancelof
Upload A Picture Of Each Owner's Drivers License (Upload images at same time)

IMPORTANT NOTE: We will need a picture of the front and back of each owners driver's license
Cancelof
Upload Each Practice's Proof Of Insurance (General Liability Insurance)

Cancelof
Owners Information

First NameLast Name
Email
example@example.com
Upload Headshot Of The Practice Owner

Cancelof
Upload A Picture Of The Owners Driver's License (front and back)

Cancelof
Upload Proof Of Insurance (General Liability Insurance)

Cancelof
National Provider Indentifier
Dentist License From (your state) Dental Commission
Doctor Info: Education, Degree, Year Graduated, Residency, Year Completed
Solar
Solar Business Name
YesNo
YesNo
List Each Owners Full Name, Physical Location, And Email Address
For example: Bob Johnson, Business Address, BJohnson@business.com. Then press enter to enter the next owner.
Upload A Headshot Of Each Of The Owners (upload images at the same time)

Cancelof
Upload A Picture Of Each Owner's Drivers License (Upload images at same time)

Cancelof
Upload Proof Of Insurance For Each Location (General Liability Insurance)

Cancelof
Owners Information

First NameLast Name
Owners Email
example@example.com
Upload Headshot Of The Owner

Cancelof
Upload A Picture Of The Owners Driver's License (front and back)

Cancelof
Upload Proof Of Insurance (General Liability Insurance)

Cancelof
Should be Empty:

Google Guaranteed/Screened Pre-Registration Form

Business Details

Storage

Dentists

Solar