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LSA ACUPUNCTURE FORM 2

Business Information

OWNER'S FIRST & LAST NAME
OWNER'S FIRST & LAST NAME
First
Last

Maximum file size: 314.57MB

THE FOLLOWING IS NEEDED PER DENTIST

ACUPUNCTURIST FULL NAME
ACUPUNCTURIST FULL NAME
First
Last
SERVICES THAT THIS SPECIFIC ACUPUNCTURIST IS LICENSED TO PERFORM:
By selecting one of these services, you confirm that this dentist carries relevant licenses required to perform work offered and booked through the Local Services Ads platform at all times. Per Google’s Minimum Provider Requirements, You are solely responsible for maintaining compliance with applicable law, regulations, and licensing requirements in each jurisdiction where you provide services. Google LLC may request proof for a relevant license or registration from you at any time. Failure to provide proof of valid licenses or registrations may cause your ad to pause.
IS THIS ACUPUNCTURIST A BUSINESS OWNER AND/OR SENIOR PARTNER?
WOULD THIS ACUPUNCTURIST LIKE TO BE FEATURED? (If yes, Please send a headshot)

Maximum file size: 314.57MB

PAYMENT INFORMATION / CREDIT CARD INFOMATION

Billing & Budget Information

Please specify both the amount and timeline (example: $1,300 per Month)