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Applicant Information

Business Name(Required)

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Business Address(Required)

Street Address City State ZIP Code

Street Address(Required)

City(Required)

State(Required)

Zip(Required)

County(Required)

Contact Name(Required)

First Last

Job Title(Required)

Mailing Address

If different than address above.

Street Address City State ZIP Code

Phone(Required)

Email(Required)

How did you hear about Iowa Businesses Against Trafficking?

Website link(Required)

By submitting a website link to your business, we will include it on the website for visitors to easily check out your business.

Logo upload (optional)

Periodically, SOS may feature one or more IBAT participants in social media posts or other promotions. By submitting your business logo, you will be considered for one of these promotions in the future. If you are interested, please upload your business logo.

Max. file size: 50 MB.

Business Information

Business Type(Required)

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Number of Employees

Number of Locations in Iowa

Markets Served by Applicant

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Statewide

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Describe Applicant’s Main Products/Services

Agreements for Participation

Please read each statement below. Initialing indicates you understand and agree with the statement.

Applicant understands that participating, or applying to participate, does not create any business relationship between the Office of Iowa Secretary of State, or any of its employees, beyond what is described within the application.(Required)

Applicant agrees to learn something and do something about human trafficking each year for the duration of the partnership. Our website will provide ideas and content to “Learn Something and Do Something”. However, it is not required that you use those suggestions. We encourage all participants to come up with their own best practices.(Required)

Applicant agrees to provide informational resources to employees regarding the Safe at Home program.(Required)

Applicant understands that the feature IBAT participants in social media or promotions is at the sole discretion of the Office of Iowa Secretary of State.(Required)

Certification of Applicant

I certify that I have reviewed the preceding statements and any attached supporting documentation, and to the best of my knowledge, the information provided is true, accurate, and complete. I also certify that I have the authority to execute this application on behalf of the applicant. Reference herein to, or registration by, any specific commercial entities, trade names, trademarks or service marks, or otherwise, does not constitute or imply its endorsement, recommendation, a promise of future employment or work, or favoring by the Iowa Secretary of State or the State of Iowa.

Date(Required)

Name(Required)

Person Authorized to sign on behalf of business

First Last

Person's Capacity/Title(Required)

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