Please provide the following information about your company.  Fields in RED will not be published but are used for SeniorMag management purposes only: 

Name
Title
Company Name
Street Address
Address (cont.)
City
State
Zip
Phone
FAX
Your E-mail Not Published
Contact Email Published
Website Address

Primary business location:  Pick location FL - Boca Raton area FL - Daytona area FL - Fort Lauderdale FL - Gainesville area FL - Jacksonville area FL - Miami area FL - Orlando area FL - Tampa area FL - St Petersburg GA - Atlanta area GA - Savannah area NC - Charlotte area NC - Greensboro area NC - Raleigh area SC - Columbia area SC - Greenville area VA - Richmond area VA - Roanoke area

Primary business category: 
  PICK A CATEGORY FINANCIAL - General - Accountant - Financial Advisor - Insurance - Other financial - Real estate - Tax HEALTH - General - Day/Night Care - Home Health - IV Therapy - Nurse - Nutrition - Nutritional Supply - Occupational Therapy - Pharmacy - Physical Therapy - Physician - Speech - Vision HOME MAINTENANCE - General - Cleaning - Lawn/Garden - Pool and Spa HOME REPAIR/IMPROVEMENT - General - Appliance Repair - Carpentry - Electrician - General Services - HVAC - Paint and Decor - Roofer - Windows PERSONAL SERVICES - General - Assisted Living - Companion - Errands - General Personal Services - Homecare (non-health) - Meal Preparation - Nursing Home - Transportation RESIDENTIAL - Continuing Care Retirement - Independent Assisted Living - Life Care - Memory/Alzheimer's RESTAURANT - General - Carry Out - Dine - In TECHNICAL - General - Computer Repair

Secondary business categories under which you would like to be listed:
  PICK A CATEGORY FINANCIAL - General - Accountant - Financial Advisor - Insurance - Other financial - Real estate - Tax HEALTH - General - Day/Night Care - Home Health - IV Therapy - Nurse - Nutrition - Nutritional Supply - Occupational Therapy - Pharmacy - Physical Therapy - Physician - Speech - Vision HOME MAINTENANCE - General - Cleaning - Lawn/Garden - Pool and Spa HOME REPAIR/IMPROVEMENT - General - Appliance Repair - Carpentry - Electrician - General Services - HVAC - Paint and Decor - Roofer - Windows PERSONAL SERVICES - General - Assisted Living - Companion - Errands - General Personal Services - Homecare (non-health) - Meal Preparation - Nursing Home - Transportation RESIDENTIAL - Continuing Care Retirement - Independent Assisted Living - Life Care - Memory/Alzheimer's RESTAURANT - General - Carry Out - Dine - In TECHNICAL - General - Computer Repair

Suggest a different category:

In-home services available?  Yes  No  N/A

Business hours: 

On call services available?  Yes  No N/A

Are services covered by Medicare?  Yes  No Sometimes  N/A

Emergency contact number (if any): (xxx)xxx-xxxx

Years in business:  Choose Less than 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 More than 20 More than 30 More than 40 More than 50

Associations and affiliations:

N/A  BBB  Chamber  Professional

Professional or other organizations of which you or your company are a member:

If your company is an assisted living/real estate oriented company (e.g. retirement center, group home, etc) where there is a monthly charge and you want to list a price range, enter monthly minimum and maximum figures in (U.S.) dollars:

Minimum      Maximum 

Special senior discounts or programs?  Choose N/A Yes No

Professional license?  Choose N/A Yes No

Professional license number (optional):

Other accreditations: 

Number of employees:  Pick one N/A 1-5 6-9 10-19 20-39 40-59 60-99 100-149 150-199 200-299 300-499 500+

Does your company maintain workman's compensation?  Yes  No

Other types of insurance that your company has and wants mentioned on your company profile (optional):

N/A

Does your company check employee criminal records?  N/A Yes No

Are employees bonded?  N/A Yes No

Does your location have wheelchair access?  N/A Yes No

Does your location have other handicap facilities?  N/A Yes No

Are you on a bus line?  N/A Yes No

What is your geographical area of coverage?  Hold Ctrl key to select more than one:  Note - this field is primarily for service companies that provide services at a client home.  If you require patrons to visit your location, this field probably does not apply and you should pick the N/A option.

  N/A City limits Entire metro area North metro area South metro area East metro area West metro area Other (specified below)

Other service area definition (ex. by zip code): 
 

Are references available?  N/A Yes No

Please input your text that will be used in the body of your page.  Please note that SeniorMag will not edit your text.  It should conform to our merchant rules of conduct.  You are responsible for spell-check, grammar, and punctuation.  No HTML tags are allowed.  SeniorMag reserves the right to format the text according to our site format requirements:

500-4000 characters required including spaces. Delete this text and insert your own profile text. We recommend that you use this space to describe your business or services to your client including any mention of senior discounts, etc. Important tip: Do not include text such as your company name or other information found in other fields on this page. That information is available in addition to this text. Use this space wisely to talk directly to your prospective client.

Have you reviewed and agree to SeniorMag's Terms and Conditions? 
(an answer of Yes is required)  No Yes

If you have images that you would like used on your profile, you may send it to us as an attachment.  Use your company name as the subject. Please limit images to two images and be sure that they correspond to the image rules.

Do you have images that you will be sending?  No images will be sent One image Two images will be sent

Subscription code:
If you have been given a subscription code (for example at the bottom of an email or advertisement), please insert that code above.  If you do not have an subscription code, then it is not required.