New Online Directory Service Provider Registration Form

New Online Directory Service Provider Registration Form
NAME OF BUSINESS*
Primary Contact Person*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tell us about your family-friendly services:
Description of Business:
PLEASE INCLUDE CATEGORY/INDUSTRY, HOURS OF OPERATION, LIST OF SERVICES, LANGUAGES SPOKEN. (IF CONTACT INFO IS SAME AS ABOVE, NO NEED TO INCLUDE AGAIN)
Upload File (LOGO or PROFESSIONAL HEADSHOT)
MESSAGE TO FAMILIES: (ADVERT TEXT)

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Subscription Start Date:

MonthDayYear
Date
Desired Billing Frequency
YOU WILL NOW BE DIRECTED TO OUR SERVICE CONTRACT PAGE FOR ELECTRONIC SIGNATURE, WHICH WILL CONTAIN IMPORTANT INFORMATION YOU SHOULD FAMILIARIZE YOURSELF WITH. PLEASE ENSURE YOU HAVE READ THE ENTIRETY OF OUR SERVICE AGREEMENT BEFORE SIGNING AND SUBMITTING PAYMENT. IF YOU HAVE ANY QUESTIONS PLEASE REACH OUT TO US AT CONTACT@NANNYSTANDARD.COM BEFORE SUBMITTING THIS FORM.
My Subscriptions
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Monthly Service Directory Ad Placement
$15.00 for each month

Yearly Service Directory Ad Placement
$100.00 for each year
Should be Empty: