1.
Full Name
2.
Email Address(es)
(additional email address)
(additional email address)
3.
Name of Agency/Agencies
(additional agency name)
(additional agency name)
4.
URL(s) of Agency/Agencies
(additional agency URL)
(additional agency URL)
5.
Business Address
Street
Apt/Suite/Office
City
State/Province
Zip/Postal Code
Country
6.
Phone Numbers
Business 1
Business 2
Business 3
Personal
Cell
Other
7.
Names of Owners
1
2
3
8.
What was your initial Exotic Publishing "Code of Ethics" transgression(s)?
9.
How many times did this occur?
10.
Why did this happen in the first place?
11.
What procedures have you put into place to ensure this doesn't happen again?
12.
Why do you wish to be reinstated to our membership program?
13.
Additional Comments:
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