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Part I - Company Information for the Database

Company Name:
Contact:
Street Address:
City:
State:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY	Zip:
Business Phone:
Toll Free Phone:
Fax Phone:
Email:
Web Site:

Part II - Service Information

Listing Category: (select only one)

Referral Agency Insurance Employment Screening

Referral Agency Services: (check where appropriate please)

We refer: Nannies Housekeepers Eldercare Companions Temporary/On Call Child Care

We refer:
Live In Only Live Out Only Live In and Live Out
Full Time Only Full and Part Time Temp/Emergency

We require a deposit. Yes No      If yes, amount $

Our fee is $

Our Guarantee Period:

Part III - Enrollment Information
I am interested in the following (Choose One):

Please note that paid advertising will require a completed and signed insertion order. You many download from here.

Nationwide Link (listing all 50 states) PAID ADVERTISING
NannyNetwork.com Deluxe Multiple Listing (listing up to 8 states) PAID ADVERTISING
NannyNetwork.com Basic (listing up to 3 states) PAID ADVERTISING
I do not wish to link to/publish a web page at this time. Please enter my standard listing. NO COST - ONE STATE ONLY

Advertising Terms and Conditions

1. All NannyNetwork.com advertisement must be pre-paid. NannyNetwork.com will invoice for advertisement quarterly in advance. Advertisement will be suspended for past due accounts. Reactivation fee will be assessed. $50 charge for returned checks. $100 service re-establishment fee.
2. NannyNetwork.com resume access service is available to nanny placement and referral agencies only.
3. 15 days written notification required for cancellation of advertising services.
4. NannyNetwork.com advertisers are responsible to notify NannyNetwork.com of changes to address, phone numbers and personnel. NannyNetwork.com assumes no responsibility for the accuracy of this information.
5. Listing of toll free (800 and 888) numbers is not available in NannyNetwork.com directory listing. Listing of toll free numbers is reserved to advertisers with basic, enhanced, deluxe or nationwide links.
6. NannyNetwork.com reserves the right to make pricing changes upon 60 days advance notification to advertisers
7. Paid Advertising requires a completed and signed insertion order. Click here to download document. This will open the document in a new browser window.

By submitting this form, you agree to the terms and conditions outlined above.