Under what name(s) does your company operate? Please list all current or former names.

How many offices do you have?

In what state(s) do you operate? If you operate offices outside the United States, please list those countries also.

How many Reports have been filed against you on Ripoff Report? Please include different names and the amount of Reports listed for each name.

How many years has this company been in business?

Briefly describe what most consumers complain about.

Has your company ever been sued under any of the business names listed above?

How many times?

Our program requires accepting responsibility for past problems and a commitment to making things better. Will you be willing to accept responsibility for mistakes made?

Please list any changes to your business you have recently made or plan to make that will help fix Rip-off Report problems.

What is the average dollar amount of your sale? Please give a range, from lowest to highest.

Name of person filling out this form:

Are you an Owner?

Position with the Company, if not an Owner (ex. President or CEO, Counsel, Other):

Contact information:

Remember, all answers are confidential and strictly for the purpose of determining suitability for the Corporate Advocacy Program. If you have any questions, please contact us.