Agency Information Form:  (required information for your listing)

The following information is needed to complete your listing.  After you have filled out this form and submitted it, you will be taken to the purchase page where you can select your subscription option and submit your credit card information by way of our secure server. 

Please DO NOT TYPE IN ALL CAPITAL LETTERS.

(If your purpose is to update an existing listing, please check here and specify exactly what needs changing in the additional comments box at the bottom). Do not forget to give us your agency name and state.

* Agency Name
*Owner
*Title
*Street Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
*Country
*Work Phone
FAX
*E-mail
URL

* Please check if you are a current member of :
   International Nanny Association (INA)
   Association of Professional Nanny Agencies (APNA)

*Do you require a Deposit ?

Yes No

* If yes, please give a dollar amount for your deposit ?

* What is your current fee (as of December 2005 ) for placing a full-time Nanny? 
          

* What is your Replacement Policy?
Replace Nanny: 30 days Replace Nanny: 60 days Replace Nanny: 90 days Replace Nanny: 120 days Replace Nanny: 6 months Replace Nanny or Refund portion of placement fee None Other

*Please describe (briefly) the services you provide (i.e., Live-in, Live-out, full-time, part-time, temporary, summer nannies, etc.) 

*Where do you place? International US National US Statewide US Local UK Ireland Canada

*What year was your company established ?

Additional Comments

Would you like information about how NannyClassifieds.com can help you recruit qualified nannies? Yes  No

Send any questions you have about this form, advertising on our website, or our Referral Network here.