1. Your Company Name (leave blank if you are an individual)* If you are submitting on behalf of customers, this would be your CUSTOMERS name, not yours.
   
2. First and Last Name (full name required)
3. Email (not public)* If you are submitting on behalf of customers, we highly recommend using YOUR email, not your clients.
   
4. Phone (not public)
5. Website URL
6. Description of Product/Services provided by the Vendor/Member Please describe product or service purchased.
   
7. What year did you purchase the product/service
8. Input Your Testimonial
9. Upload Your Logo
10. Upload Testimonial/Endorsement¹
11. 2 + 2 =
12. Security Code

¹ Your testimonial/endorsement should be a JPG image or a PDF document.