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Verification Application Complete the form below to apply for Veriza Verification™. For more information about the benefits of Verification, please visit Seller Services. Submission of this application constitutes your agreement with the Veriza Terms of Service. and your pledge to uphold the Veriza Standard of Customer Service. *=required fields Step 1 of 3 .Applicant Information *Full Name Business Name Your Title Choose Owner Partner Secretary other: Business Website(s) Tax I.D. # *Customer Service E-mail Address *Business Phone Number Phone number listed on your Veriza Page? Yes No Business Fax Number Fax number listed on your Veriza Page? Yes No *Business Address Street Address Line 1 Street Address Line 2 City, State, Zip, Country .Seller Details *Your eBay® or other Auction Seller Username Years as an Online Auction Seller 0-1 1-2 2-3 3+* *Auction sellers registered for 3+ years may qualify for our Veriza Premier Program. Thumbnail Image URL Help Will appear on your Veriza Page. Must be 100x100 pixels or less. ex: http://www.veriza.com/gx/seal1.gif *Describe what you sell Seller of... Veriza Home .|. Get Verified .|. Seller Services .|. Bidder Services .|. Search Verified Sellers Directory .|. Fees .|. Help .|. Contact .|. Terms of Use .|. Privacy ©2003 Veriza.com - All Rights Reserved.

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