AFRICAN AMERICAN BUSINESS DIRECTORY

INSTRUCTIONS:   This Submission Form is designed to allow you to select your Directory City, Business Category, and Preference, print the form, and complete it off-line at your leisure.   Then mail it with either certified funds or with credit/charge card information for the $50.00 Listing Set-up Charge.  This will establish your business' presence in a comprehensive African American Business Directory on the Global Internet.  Your Submission Form must be accompanied with either certified funds (bank check or money order) or credit/charge card information and signature.  Please allow two to three weeks for your Directory listing.  Please follow these instructions:

1.   Click the Arrow for City Category and select the City in which your Business is to be listed.  If your city is not listed, choose the city nearest to you;

2.   Click the Arrow for Business Category and select the Category most representing your Business.  If none is representative, choose the "Professional, General" Category;

3.   Click the Arrow for Preference and select the one which represents your Business;

4.    If Standard Industry Codes (SIC) refer to your business, enter up to four.  You can click the link to go to a website to lookup SIC codes.  Click "BACK" to return to this form;

5.   Print this page (form) on your local printer and complete it off-line by typing or print with  black/blue ink; and

6.   Mail your completed Directory Listing   African American Business Directory,  P. O. Box 1535,  Landover, MD  20785-1535.

Please Select the Directory City to list your Business:   

Please Select your desired Category:      

Please Select Your Business Preference:   

Enter Up To Four Business Standard Industry Codes (SIC), If Applicable:
        ** Look Up SIC Codes Use BACK Button to Return: 

   SIC 1   SIC 2   SIC 3   SIC 4

Please enter information as you wish to have it presented in the Directory:

Name Of Your Business: _____________________________________________________

Federal ID No. or Social Security No.:   ___________________________
   (Federal ID or Social Security information is not displayed, it is for business identification only.)

Enter The Unique Specialty of your business:
(200 Characters or less, including spaces)
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
 Address 1:  _______________________________________________             
Address 2:  ______________________________________
City:  __________________________________      State: __________
Zip+ 4, if used(zzzzz-xxxx):    __________________________________
Contact Person:  ___________________________________________
Phone No. w/Area Code (xxx-xxx-xxxx):    ______________________
Extension:  ________     Fax (xxx-xxx-xxxx):  ______________
E-Mail Address (if available):   ______________________________
WebSite Address (if available):  ______________________________

Simplest Directions From Nearest Major Thoroughfare:
(200 Characters or less, including spaces)
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

RESPONSIBLE PARTY INFORMATION:

First Name/Initial:  _________________________________________
Last Name:  ______________________________________
 Mailing Address, Street 1:    _________________________________
                             Street 2:   _________________________________
City:  _______________________________       State:      _____________
Zip+4, if Used (zzzzz-xxxx):   _____________________________
Telephone No. w/Area Code (xxx-xxx-xxxx):    ____________________

PAYMENT METHOD (Select One):

[  ] Payment via Certified Funds Mailed In With Application
        ***Attach Certified Funds in the amount of $50.00 for the Listing Set-up Charge.
        ***Omit the remainder of this Application Form***

[  ] Payment via Credit/Charge Card
        +++Complete the Credit/Charge Card Information and Signature.+++
        +++The $50.00 Listing Set-up Charge will be charged to this account.+++
        +++Complete the Following Section.+++

CREDIT/CHARGE CARD PAYMENT INFORMATION:
  **(Payment information is held in strictest confidence and is not available to anyone.  It is for the Directory Listing payment only.)**

Select the Credit/Charge Card:

[  ] VISA      [  ] MasterCard     [   ] American Express   [  ] Discover/NOVUS    

Account No. (Write in manually):

                

Expiration Date [mmyy], (Write in manually):       

    

Name Exactly as on Card: ______________________________

Address on Credit/Charge Billing:
Street 1:  _______________________    Street 2:   ____________________
City:   ___________________________________      State:  ____________ 
Zip+ 4, if used(zzzzz-xxxx):    ______________________________________

 Your Credit/Charge Authorization Signature (Required):

X________________________

Signing This Application Is Your Authorization To Charge The Subscription Plan Amount To Your Charge/Credit Card:

**Please double check your entries, because there is a minor ($25.00) fee for changes and modifications to your business record**

Thank you for your Directory Listing and Welcome!!! to our Directory Family.

 

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