Join Golden Providers – Golden Providers

Thanks for joining Golden Providers!

Step One – Review & Agree to our Member Code of Ethics:

MEMBER CODE OF ETHICS • Any referrals or leads generated through Golden Providers will be addressed within 24 hours. Phone calls and emails will returned within 24 hours. • Your business must remain licensed, insured, and in good standing with the Better Business Bureau. Failure to comply with this requirement could result in immediate termination from Golden Providers and forfeiture of annual dues. • All licenses and required insurance must remain current and up-to-date. Proof of licensure and insurance can be requested by Golden Providers Board administration annually or upon request. Gaps may cause for termination from Golden Providers. • Membership may be terminated at any point in time with a unanimous board decision. Membership status can be reviewed based off Better Business Bureau results. • Members will honor their commitments to the client and to one another. • Any disputes amongst members should be handled discreetly between members. In the event that you need assistance, the Board should be approached for guidance and direction. • Recognizing that each of us have existing relationships, members will endeavor to support, encourage, and refer members of Golden Providers. I HAVE READ AND AGREE TO THE GOLDEN PROVIDERS MEMBER CODE OF ETHICS

Signature of Authorized Representative:

(Full Legal Name / Date Signed)

Name *

First

Last

Email *

Company Name:

Message

Step Two – Submit Golden Providers Membership Application Online:

Go to Person: *

First

Last

Email *

Your Direct #: *

Business:

Address (with City/State/Zip):

Business Phone:

Cell Phone:

Fax Number:

Web Address:

Position:

For How Long?

Occupation

Full Time
Part Time

Product/Service Description

(suggested description of Product/Service as it will appear on the Directory/Web)

Licenses/Certifications/Boards (Please Specify):

City/County/State License(s)
Certification(s)
Business Card

Please scan and email any speific items noted to: Info@GoldenProviders.com.

Past Experience in Field/Occupation:

Related Experience & Background - Please scan and email additional page(s) if necessary

Your Education/Background in Field/Occupation:

Related Experience & Background - Please scan and email additional page(s) if necessary

Have you ever been convicted of a felony or have there ever been any successful judgments or lawsuits against your company?

If Yes above, please explain:

Reference #1 (Name / Phone / Email)

Reference #2 (Name / Phone / Email)

Reference #3 (Name / Phone / Email)

I authorize the verification of the information provided on this form. By adding my name in the signature block below, I verify that my business meets and will abide by the code of ethics. It is my due diligence to bring it to the attention of the board of directors if, at any time, my business fails to meet any of the requirements to be a member of Golden Providers. Membership may be subject to termination if I fail to meet any of the following or have a breach in coverage. I have retained a copy of this application for my records. I acknowledge that Golden Providers requires Members to provide Business/Professional License (when applicable), Active Business Insurance (where applicable) and to be in good standing with the Better Business Bureau.

Signature (Full Legal Name) & Date Signed