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Women's Business Assistance
Forum
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To
learn more about the reason for the fees and self-sufficiency, click
here. Contact name: _______________________________________________ Company name: ______________________________________________ Company address: _____________________________________________ City, State, Zip: _______________________________________________ Business area code and phone number: ___________________________ Cell area code and number (if used): _____________________________ Email address: _______________________________________________ Website URL: ________________________________________________ Business service specialties (maximum of 5 for introductory offer): 1: _________________________________________________________ 2: _________________________________________________________ 3: _________________________________________________________ 4: _________________________________________________________ 5: _________________________________________________________ By signature below, I attest I/my company is fully qualified as allowed by law to perform services as shown above. I herein indemnify WBAF, WBC, Emerging Business Centers, Inc. and Services Cooperative Association from any and all liability associated with my performing services regarding WBAF referrals from this site. Further, I am a woman owned business, have been in continuous operation for one (1) year or more and serving as an independent contractor with respect to this agreement and, if requested, will provide references of satisfied customers who have used my firm's services to become certified as a service provider. Additionally, I am not subject to any management, supervision, deductions, withholding or benefits by WBC. I agree that no referrals are being promised/guaranteed and that WBC will serve as sole arbitrator should any conflict arise between myself and any customer/client referred by WBAF. Finally, I agree that fees for my services to WBAF customers/clients will be at my lowest rate and are subject to verification by WBC. Signature:________________________________________
Date: _________________
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