Notice Form for Service Providers

Name*
First Last
Business Information*
Job Title Company Name Company Website
Work Phone*
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Do you and/or your organization charge fees?*
How many service providers are with your organization?*
Describe the services you offer to clients:*
Describe when you started providing this service:
Are you aware of other parties providing a similar service?*
Please explain how the services you provide enhance access to justice:*
Do you appear before courts, tribunals, or boards?*
Which courts/tribunals/boards do you appear before?*
Describe the structure of your business:*
Small/solo, co-op, government, sole-proprietor, non-profit, corporation, etc.
Do you or your organization have insurance for the services provided?*
Please provide details of the insurance you have:*
Where did you learn about our limited licensing initiative?*