	Required Field
Contact Information Personal contact information will not be made available to the public.
Contact Name: Contact Name is required.
Address: Address is required.
City: City is required.
State: State is required.
Zip: Zip is required. Zip is invalid.	Ex: 12345-6789 or 12345
Phone Number: Phone Number is required. Phone is invalid.	Ex: (317) 555-1234 or 555-1234
Email: Email is required. Email is invalid.	Ex: someone@somewhere.com
Business Information Business Information will be made available on DVA's Service Page.
Company Name: Company Name is required.
Company Website URL: Company Website URL is required.
Company Phone Number: Company Phone Number is invalid.	Ex: (317) 555-1234 or 555-1234
Company Location:
Industry: Industry is required.
Indiana Location Where Services Are Available: Indiana Location is required.
Company Description: Please provide a short description of your company. Limit 4000 characters. Company Description is required.
Company Picture Please provide a photo of your company to be placed on the website as a thumbnail and full size photo. File types accepted: PNG and JPG. File size limit: 5MB.
Company Logo Please provide a photo of your company logo to be placed on the website as a thumbnail and full size photo. File types accepted: PNG and JPG. File size limit: 5MB.
Services Page URL: Please include the URL for your company's services page listings. We will place a "Proceed Now" button on the Non-Employer VOP page that will link applicants directly to your company's services listings page.