EAPage.com Virtual Marketplace Listing Form Vendor Application Form

This is a comprehensive form. Please answer as many as are applicable. It will be sent directly to our tech people to begin adding your listing. Make sure you check for accuracy. Not all information is applicable to all listings.

 

Referred by: 

I wish to be listed in: (Check all that apply)

Provider Section as an Individual,( $45.00)Group,($80.00) or Multi-service ($150.00).

Provider Renewal ($25.00 per year)  -If renewing, just check here and add any changes you want to your listing by filling in the changes below  then submit form and go to the payment page. Renewals get re-announced!

Vendor Section ($100.00) in the National, International and/or State/Local Section(s). (Separate charges apply)

Vendor Renewal ($50.00 per year)  -If renewing, just check here and add any changes you want to your listing by filling in the changes below  then submit form and go to the payment page. Renewals get re-announced!

As an Advertiser($ 200.00 per 6 months)- Advertisers receive prominent placing and inclusion in all resource updates to our mailing list.

1.  Please provide the following contact information (all listees):

Name
Title
Organization
Street address
City
State/Province
Zip/Postal code
*County  Providers are listed by county!
Country
Work Phone
FAX
E-mail
URL

2.  Please enter brief introduction to your services that will be used in an E-Mail announcement to EAPs, Mediators and Vendors.  Please keep under 150 characters. (Providers list three specialties; multi-services include all the services you offer)

3.  Please indicate the background colors you would like and the color of the text.

4. Vendors can choose 3 focus areas.  A separate banner is placed in each focus area.  Please indicate which areas are your preference:

External EAP Provider     Crisis Intervention

Workplace Violence Drug Testing   Mediation 

Childcare/Eldercare Research/Design/Eval. 

Newsletters  Clinical Networks  IT Solutions    

Training/Coaching    Legal/Financial Services  DOT/SAP

Faith Based Counseling  Expatriate Services

Other  

5. For each focus area, you can write a short description specific to each focus area (recommended). Focus area 1 should be your primary focus.  Please use the box below for all 3. Make sure you identify each focus area.

6. Vendors can add to their listing, the top ten criteria they believe a decision maker should consider when selecting an EAP. 1= most important.

7. Do you have a logo you would like to use?Yes  No  

All vendor submissions are listed in order of receiving information and payment status in good standing. If you would like to move up in listing order, there is a $50.00 fee for each position you move up.  To qualify for this, a credit card must be kept on file. You have the option to be notified if your position changes by another's move. If you would like to be notified please check here.

If you would like to be initially be placed higher, check here and you will be contacted.

8.  Providers can be listed under several different headings. Please check which applies to you.

Treatment Provider (default heading)    

Recommended Treatment Providers - treatment providers who are recommended by EAP professionals. Please indicate EAP that can validate your work.     

EAPPP (Employee Assistance Professional in Private Practice)

CEAP

 
 

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