Please print this form, fill it in as completely as possible, and fax it to us at 1-866-584-5439.

Company name __________________________________________________________

Primary contact person ____________________________________________________

Title (President, Owner, etc) ________________________________________________

Address ______________________________________State _____ Zipcode _________

Name of the County your business is located in __________________________________

Phone numbers ____________________________________ fax ___________________

Email __________________________________________________________________

Website address _________________________________________________________

Do you have a preference for your JaniQuest email address? Most email addresses are

formatted in one of three ways: for Bob Jones, it would be bjones@janiquest.com, or

bobj@janiquest.com, bobjones@janiquest.com, or you can use your company name, as in abcjanitorial@janiquest.com

Whatever email address you specify, it will forward to your email address you’ve listed above.

(You don’t have to have a JaniQuest email address, and you can ask for one free anytime).

Preference _________________________________ Or check here __ for no address now.

Now we’ll set up your listing in the “Find a Contractor” results page.

Here’s a sample of a results page. You can also see it by going to www.janiquest.com and entering

the zipcode 35004 into the box at the top of the page.

Do you have a picture or a logo that you would like to appear on the “Find a Contractor ” results

page? If you don’t have a picture now, we recommend you get one taken. Another option is to

have your company logo appear as the picture.

If you don’t have a photo or a logo, we can make the JaniQuest logo appear as the picture.

If you come up with a photo or logo later, we can insert it later at no charge.

Check one: I’ll email you a photo or logo _______ Use the JaniQuest logo for now _______

Or we can go to your website and copy your logo - please initial here _______ to give us your permission to do so.

The only image formats we can load into the picture frame are .jpg, .jpeg, or .gif, and it has to

be emailed to the_janiquest_team@comcast.net

Since your emailed photo will be sent separately from this faxed document, be sure you tell us

your company name in your email so we can insert it into the correct listing.

Which website address would you like to appear in your listing? www.janiquest.com ____

Your company’s website address you’ve listed above ____ both addresses ____

For the “Memo” section of the Results page (where we have the text “Serving the Greater Moody

Business Community Since 1999”), do you have a motto or saying that you would like to appear?

It’s recommended that you try to keep it short. Choose one:

No motto ______ Use this motto _____________________________________________

Other suggestions: “Taking Janitorial to the Next Level” ___ “Cleaning at a Higher Level” ____

“Providing Clean, Safe and Secure Business Environments” ____

Do you have a preference for your username and password for the Member’s Only website? We recommend that you choose a username that you can easily remember, and highly recommend

that you choose a password that is entirely different from any other passwords you might have (for instance, do not use your email password). And since the Forum is a venue where you can interact

with other members anonymously, we also recommend that you choose a username that doesn’t

identify your name, your company, or where you’re located. For instance, “janman” (which is already

taken, sorry) or “bobj” are better than “abcmoodyalaska”.

Preference for username __________________ preference for password ___________________

Form submitted by (please print name) ____________________ Signed ______________________

That’s it for now! Give us a day or two to integrate all of this information, and when you’re all set up

we’ll send you an email so you can look everything over and let us know if we need to change anything.

Fax this to 1-866-584-5439, and remember to email that photo or logo. If you have any questions,

send an email to the_janiquest_team@comcast.net or alex@brandmother.com