Acid Test Registration Form

Self-Reliance And Security For
Contract Employees.

YOUR COMPANY NAME
Supports Full Disclosure

The Contract Worker's Bill of Rights

Registration Form

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Contract Brokers: Complete and submit this simple registration form to display The Acid Test Logo on your firm's web site.


Name of Firm	Area Code + Phone Number
E-Mail Address	Web Site URL

Your Full Name	Your Position

Business Address/P.O. Box	City
State/Province	Zip/Postal Code
Country

Select the services your firm provides. If you check "Other" in either list, explain in the text box at bottom of this form.
Agency Type Full Service Recruiting Stand-alone Job Matching Service 1099 Pass-through (Payroll) Service W-2 Pass-through Service Umbrella Service A La Carte Menu of Services Other?	Contractor Type W-2 Contract Employee 1099 Independent Contractor Corp Independent contractor Other?

Use this text box to elaborate on the services of your firm, including incremental service fees, and any other pertinent information.
"By submitting this form I attest that my firm will adhere to the principles and guidelines of the Contract Worker's Bill of Rights. I am authorized to register my firm to display The Acid Test Logo in my firm's web site."
Please Click Once

HTML script and instructions for displaying The Acid Test Logo are on the response page to this submission.

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