Legal Business Name: _____________________________
DBA: __________________________________________
Address: ________________________________________
City: _______________ State: _______ Zip: __________
Tel: ______________________ Fax: _________________
Email: __________________________________________
Web Page: _______________________________________
Principal: ______________ Contact: __________________
Type of Business: _________________________________
Have you ever done any type of barter? _______________
Have you ever been a member of another barter company?
YES NO If yes which? ___________________
What services and or products would you like to trade?