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CommunityLink Direct Impact Certification Application Form

Business Information

Purpose: Verify identity, contact details, and legitimacy.

Business Name *

Legal Business Entity Name

Business TypeFor-ProfitNon-ProfitGovernmentOther

Select Primary Industry / Service Category

Add Primary Industry / Service Category

Business Address *

City *

State/Province

ZIP / Postal Code

Business Phone Number *

Website URL

Contact Person Name *

Title *

Email for Certification Correspondence *

Verification Documents

Purpose: Establish legitimacy and compliance.

Business License or State Registration Certificate *Upload Business License or State Registration Certificate

No file chosen

Proof of Insurance (if applicable)Upload Proof of Insurance

No file chosen

Tax ID or EIN (last 4 digits acceptable)

Proof of Active OperationRecent invoiceWebsitePublic listingSocial media business page

Additional supporting filesUpload additional supporting files

No file chosen

Community Commitment

Purpose: Capture their pledge to positive community impact.

To receive or maintain certification, every business must contribute at least one tangible action toward community well-being each year. Please select all that apply.

Host or sponsor free community events or classesOffer discounted or pro bono services for vulnerable populationsPartner with local nonprofits or schoolsHire locally or offer internships/apprenticeshipsDonate surplus goods, food, or resourcesSupport environmental sustainability (reduce waste, recycle, etc.)Provide educational outreach or health awareness campaignsOther

Please Describe

Attach proof or description of one recent community initiative.

No file chosen

Ethics & Compliance

Purpose: Protect consumers and your brand.

Have you or your business been subject to legal or regulatory action within the past 24 months?YesNo

Do you agree to notify CommunityLink of any major compliance or ownership changes?YesNo

Do you agree not to use your certification in a misleading or deceptive way?YesNo

Do you consent to annual re-verification and random audits of your certification status?YesNo

I certify that all information provided is true and accurate to the best of my knowledge. I understand that certification may be revoked if false information is discovered or if ethical standards are not upheld.

I have read and agree to the CommunityLink Certification Terms and Conditions.

Payment

Purpose: Automate application or renewal fees.

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