Google – Local Service Ads Submission Form Client LSA Business Name * Legal Business Name * (Name your business is registered with the government) Business Phone * Website/URL * Owner First Name * Owner Last Name * Total number of fieldworkers * Year Founded * Business Address * Business Address Business Address Business Address Business Address Business Address State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Business Address Is This A Location That Customers Can Visit * Yes No (like a store or office) List Your Top Service(s) Offered * What Are Your Service Area(s) * What Service Area(s) Would You Like To EXCLUDE * Drivers License Photo - Front * Drop a file here or click to upload Choose File Maximum file size: 268.44MB Drivers License Photo - Back * Drop a file here or click to upload Choose File Maximum file size: 268.44MB Proof Of Insurance * Drop a file here or click to upload Choose File Maximum file size: 268.44MB Upload a PDF file to show proof of insurance. The file should contain current documents of general liability insurance for the practice.A certificate of insurance document must clearly show the amount of liability insurance and the expiration date, and the policy must satisfy the minimum insurance amount specified by occupation here: $250,000 for Water Damage Service Provider. Learn more If you are human, leave this field blank. Submit
