See page 7 for Certification fees

Size: px
Start display at page:

Download "See page 7 for Certification fees"

Transcription

1 About Certification Many corporations, especially those in the National Minority Supplier Development Council Network, have special programs designed to assist minority owned firms to meet with their needs. In order to ensure that these programs are focused on those for whom they were intended, "Certification" was established a number of years ago. In order to be certified as a bona fide Minority Business Enterprise (MBE), a firm must be: Legally organized. Established as a full-time, profit-making entity At least 51% owned by a United States Citizen or a Naturalized Citizen who is African-American, Hispanic-American, Native-American, Asian-Pacific American or Asian-Indian American. The minority group member(s)' ownership interest in the firm must be real, substantial and continuing. Under the day-to-day control and guidance of a minority group member. At its simplest, certification is a verification of statements that one is a minority, who owns and manages a firm. This verification is established through a thorough examination of various documents, on-site visits and interviews. The documents examined depend on the type of organization that the firm has adopted - sole proprietorship, partnership or corporation. See page 7 for Certification fees

2 GENERAL INSTRUCTIONS In order to become a certified minority supplier of the New York & New Jersey Minority Supplier Development Council, Inc. (NY & NJ MSDC) certification is mandatory. Please complete the application in its entirety and forward it to the Council office at the address listed below. Failure to comply may result in a rejection of your application. The following information is required of all applicants for certification: 1. Answer all questions. 2. If a particular question does not apply to your business operation, please write "not applicable" in the space provided. 3. Where more information is needed than the space permits, write, "see attachment" and attach the information to the application. 4. Complete the certification checklist before submitting the application. All applicants must sign and date the affidavit at the bottom of the application. Certification with NY & NJ MSDC is not automatic. It is your responsibility to comply with the requested information and documentation in a prompt and timely manner. Please return this application, documents, and non-refundable application-processing fee. A $40 returned check fee will be charged for any returned checks. Checks should be made payable to: New York & New Jersey Minority Supplier Development Council, Inc. 320 W37 th Street 9 th Floor New York, NY If you have any questions on any of the above, the content of this application; or the Regional Council in general, please call the certification department (212) See page 7 for Certification fees

3 1 General Instructions: New York & New Jersey Minority Supplier Development Council, Inc. CERTIFICATION APPLICATION TO EXPEDITE CHECK THIS BOX DR When answers require additional space, use plain white paper. Properly identify the item referred to by the appropriate number. At the top of each additional answer and exhibit, state the name of the applicant, date of the application and item number. Please answer all questions as completely as possible: if a particular question does not apply to your business operation, write not applicable (NA) in the space provided. You must include all attachments requested on page 8. Also the application must be signed, dated, notarized and include non-refundable fee SEE PAGE 7 FOR FEES Date of application: / / (Day, Month, Year) D&B Number: NAIC Codes: 8a Certification Number: (To find your NAIC Code please go to: You must submit your NAIC code with your application to prevent rejection ) (NAICS CODES MUST BE 6 (SIX) DIGITS BUSINESS INFORMATION Name of Business President President's address (required) Business Street Address Fax Number Web site Address Mailing Address (if different from Business Address) Date Business Was Established: / / Date of Acquisition (check one): Bought existing business Started business Secured a franchise Merger or consolidation Other (please specify) Is your business a home-based operation? Yes No List or attach location of all additional facilities:

4 2 List all professional license(s): Major Products and/or services offered: Current Gross Annual Sales: Legal Structure (check one): Can you supply products or services: Local Regional National Number of Actual Employees: Proprietorship LLC Partnership LLP Total Number of Employees: Corporation Total Number of Minority Employees: Federal IRS ID Number: Type of Business (check one): Manufacturing Construction Service Finance Professional Services Broker Other Transportation Distributorship CUSTOMER BUSINESS REFERENCE Customer Name Buyer Fax Number Product/Service Quality Approvals (if applicable) Customer Name Buyer Fax Number Product/Service Quality Approvals (if applicable)

5 3 Customer Name Buyer Fax Number Product/Service Quality Approvals (if applicable) Customer Name Buyer Fax Number Product/Service Quality Approvals (if applicable) BANK AND CREDIT REFERENCES List Your Bank and Credit References:* Name of Institution Address Type of Account Credit Line Name of Bank Officer Title Name of Institution Address Type of Account Credit Line Name of Bank Officer Title

6 4 List Other Credit References: Name of Institution Address Type of Account Credit Line Name of Bank Officer Title *Note: Please submit copies of all existing banking resolutions along with signature cards. CONSTRUCTION INFORMATION (if applicable) Trade Specialty: Bonding Agent: Bonding Capacity: *Please send copy of Bonding Certificate Authorities/Licenses (list all professional licenses): Union Name: Union Affiliation: Union Local: Project Name: (most recent) (largest) Geographical Area: Start Date: / / / / Finish Date: / / / / Dollar Value: TRANSPORTATION INFORMATION (Transportation Carriers Only) Operating Status: Independent Carrier Common Carrier List the Commodities You Normally Transport: NY & NJ MSDC Certification Application, Page 5

7 5 Operating Authorities: Interstate Intrastate Insurance Carrier: None: Please submit proof of insurance coverage. List All Vehicles and Equipment: Vehicles and Equipment* Owned/Leased? Registration Number Please forward copies of all applicable vehicle title and/or lease agreements with this application. PLANT INFORMATION Plant Address Program Manager Facilities (Total Available Space) Office Square Feet EQUIPMENT INFORMATION List Your Basic Operating Equipment: Owned Leased Please include a copy of Lease Agreement(s)

8 6 MANAGEMENT INFORMATION A. List the names of: Each proprietor, partner, officer, director and stockholder. The names listed should include Minority Group Members and Non-Minority Group Members. Under ownership column note if S (stockholder, proprietor or partner), D (director) and/or O (officer). B. Where the person is a minority group member, insert the appropriate code letter corresponding to the minority group in which he/she claims membership in accordance with the following: Citizenship Status B = Black H = Hispanic E = Asian Pacific NA = Native American O = Other C = Caucasian X = Non-Minority AI = Asian Indian 1 = Birth 2 = Naturalized Citizen Handles Ownership Daily Minority and Citizenship Management Group Percent Status Name/Title Yes/No Member Ownership C. Does the applicant business have any subsidiaries or affiliates or is it a subsidiary or affiliate of another concern? (Check one) Yes No If yes, provide the name, address, telephone number of the subsidiary, affiliate or parent. Also, describe the relationship of applicant company to the subsidiary, affiliate or parent. D. Does applicant business concern or any person listed in Management Information (B) above have or intend to enter into any type of agreement with any other concern or person which relates to or affects the on-going administration, management or operations of the applicant concern? Such agreements include but are not limited to management and joint venture agreements and any arrangement or contract involving the provision of such compensated services as administrative services, marketing, production and other types of compensated services. If yes, attach a copy of any written agreement or an explanation of any oral or intended agreement. E. Is the applicant business concern involved in any present of pending lawsuit? (Check one) Yes No If yes, provide details on a separate sheet. F. Is the applicant business concern involved in bankruptcy or insolvency proceeding? (Check one) Yes No If yes, provide details on a separate sheet.

9 7 G. Supply a copy of the applicant s financial statement for one year preceding the year of application or for the time that the applicant has been in business if less than one year, plus financial statements of any subsidiaries or affiliates of the applicant for the same period of time. If the applicant is a new business concern a copy of an opening balance sheet and projection of income, or a statement by a certified public accountant which states that the applicant is a viable business concern. All financial statements submitted to the Council must show applicable date of information given and must be signed and dated by the proprietor, partner, or authorized officer unless prepared by an independent certified public accountant. All materials will be kept confidential. H. Have you ever been rejected for certification by anyone? (Check one) Yes No If yes, state when, by whom and for what reasons: Certification Fees Annual Revenue_ Fee Class 1 Less than 1million $300 Class 2 1 million - 10 million $500 Class 3 10million - 50million $850 Class 4 Greater than 50million $950 Expedite Service(within ten (10) business days) $ (additional)

10 8 CHECKLIST OF SUPPORTING DOCUMENTS ALL 1. Birth certificates or U.S. Passports for minority owners, directors, and key personnel. 2. Other proof of minority status of owners: tribal card, family genealogy 3. Current balance sheet and income statement. 4. Two (2) years of most recently filed federal tax return with all schedules and attachment. None exits. 5. If a new or start-up business-an opening balance sheet, projection of income, sources of capital, and target customers and two (2) years of most recently filed personal federal tax return with all schedules and attachment. 6. Business loan agreements, promissory notes, and any debt instrument Include: repayment schedule, specified interest rate, security or collateral given, maturity date, consideration paid or payable, promissory note. None exist. 7. Personal guarantees for any of the above. None exist. 8. Copies of all bank signature cards or Bank Resolutions 9. Lease agreements for all property and equipment. None exist. 10. Current resumes for all owners, director, offices, managers, and key personnel. 11. Any professional service, management, or joint ventures agreements. None exists. 12. Signed affidavit. (Page 9) 13. non-refundable processing fee made payable to the NY & NJ MSDC, Inc. 14. Third-party agreements, such as rental and management service agreements SOLE PROPRIETORSHIP 15. Copy of Certificate of Trade Name or Business Trade Name. None exist. PARTNERSHIP OR LIMITED LIABILITY PARTNERSHIP 16. Business Certificate 17. Registration of LLP or RLLP. Not and LLOP or RLLP. 18. Partnership agreement and all amendments. 19. Buy-out rights. LIMITED LIABILITY COMPANY 20. LLC Certificate 21. Minutes of the annual and special meeting 22. Operating Agreement. 23. If out of state, authority to do business as a foreign LLC 24. Evidence of LLC interests (membership) CORPORATION 25. All professional and business licenses(s) that are required to do business in state and city where the application is made. 26. Article of Incorporation and amendments including date approved by state or filing receipt. 27. Minutes of the first and most recent Shareholders, Board of Directors and Corporate organization meetings 28. Corporation By-Laws 29. Both sides of all issued stock certificate(s) and the next consecutive un-issued certificate (not a specimen copy) 30. Stock Transfer Ledger 31. Proof of stock purchase 32. If an out-of-state Corporation, copy of authority to do business in the state where application is made

11 9 AFFIDAVIT OF APPLICANT Read the following paragraphs carefully! Your signature on this application indicates acceptance and understanding of the conditions. A. OMISSION of information may be cause for this application not receiving timely and complete consideration. B. APPLICANT AGREES to allow the Council representatives access to and the right to a site visit of the applicant's place of business. C. THE COUNCIL RESERVES THE RIGHT to request further information from the applicant prior to certification. D. APPLICANT AGREES to immediately notify the Council of all facts that would result in a failure to satisfy the requirements contained in the guidelines. E. CERTIFICATION may be terminated at any time for good cause by the Council in accordance with the guidelines established by the Council Board of Directors from time to time or for the best interests of the Council. F. ALL INFORMATION in this application is true and accurate and is submitted for consideration of certification and affiliate membership. G. IF the Council discovers that a statement has been made herein which the applicant knows to be false, the certification process will be terminated immediately. H. ALL MATERIALS submitted with this package shall become the property of the Council. I. DE-CERTIFICATION IS AUTOMATIC if a certified MBE has a change in ownership, control or management and does not inform its home council within 30 days of said change. J. IF THE APPLICANT is awarded certification, the applicant agrees to abide by all rules governing their status as may be determined by the Council Board of Directors from time to time. The undersigned hereby swears under penalty of law that all statements made in this application are true. The undersigned agrees to hold the Council harmless for any claim arising out of this application and agrees to indemnify the Council for any liability in connection with the certification of the applicant. Signature of Proprietor, all Partners, or President of corporation: Business Name Signature Date Print Name Signature Date Print Name Signature Date Print Name Signature Date Print Name

12 10 The undersigned hereby declares (declare) under penalty of perjury that all statements made in this application and any attachments hereto and true and correct. I understand that the $200 Registration Fee is included and non-refundable Business Name Signature of all Proprietors, Partners and President of the Corporation Date Date Date Date Please have this form NOTARIZED, retain a copy of this form for your files and return the original and the attachments to: CERTIFICATION DEPARTMENT NY & NJ MINORITY SUPPLIER DEVELOPMENT COUNCIL 320 W. 37th Street, 9 th Floor New York, NY

13 11 State of County of On 20, before me, (name) the undersigned Notary Public, personally appeared (name), personally known to me, or proved to me on the basis of satisfactory evidence, to be the person(s) whose name (s) is/are subscribed to the within instrument, and acknowledged to met hat he/she they executed in the same in his/her their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s) of the entity upon which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Notary Public (Seal) Commission Expires NOTE: Public Law , the Consolidated Omnibus Budget Reconciliation Act of 1985, which amends Section 16 of the Small Business Act, establishes penalties of up to a $50,000 fine or imprisonment of up to five years, or both, for misrepresenting, in writing, the status of any concern or small business owned and controlled by socially and economically disadvantaged individuals (a DBE ) in order to obtain for oneself or another any prime subcontract to be awarded as a result or in furtherance or any provision of federal law that specifically references Section 8(D) if the Small Business Act for a definition of eligibility.

14 YEAR 2015 CERTIFICATION APPLICATION PAYMENT FORM (Please Print or attach business card) Name: Title: Company: Address: Phone: Fax: E mail Authorizing Signature PAYMENT FORM PLEASE CIRCLE APPLICATION TYPE (Please print clearly) $ Amount Method of Payment: Please One: Credit Card: (Amounts greater than $4000 are Subject to 3.25% fees for all credit card charges) American Express MasterCard Visa Discover Card Number: Exp Date: Name on Card (please print) Title Authorizing Signature Phone Date of Order / / Special Instructions Use this area to let us know of any special invoicing procedures you would like us to honor.

MBE CERTIFICATION APPLICATION

MBE CERTIFICATION APPLICATION Chicago Minority Supplier Development Council, Inc. "Building Strategic Alliances" MBE CERTIFICATION APPLICATION Dear MBE Applicant: Thank you for your interest in MBE Certification with the Chicago Minority

More information

CITY OF COLUMBUS VETERAN BUSINESS ENTERPRISE CERTIFICATION APPLICATION

CITY OF COLUMBUS VETERAN BUSINESS ENTERPRISE CERTIFICATION APPLICATION CITY OF COLUMBUS VETERAN BUSINESS ENTERPRISE CERTIFICATION APPLICATION INSTRUCTIONS This application is used by the City of Columbus, Equal Business Opportunity Office (EBO) to assist in certifying Veteran

More information

(Insert full name of applicant company here)

(Insert full name of applicant company here) PALM BEACH COUNTY OFFICE OF SMALL BUSINESS ASSISTANCE APPLICATION FOR CERTIFICATION Please Read This Page Prior To Filling Out Application AFFIDAVIT PALM BEACH COUNTY VENDOR ID # The undersigned does hereby

More information

SHORT FORM For Use by presently certified firms.

SHORT FORM For Use by presently certified firms. Economic Development Department Minority and Women-Owned Business Enterprise Certification Application SHORT FORM For Use by presently certified firms. M/WBE Certification Application, Short Form Rev.

More information

Women-Owned Business Certification

Women-Owned Business Certification omen-owned Business Certification Enhancing Contracting Capibilities omenowned hy Become Certified? omen are changing the face of America s economy. Their businesses are increasing in number, range, diversity

More information

GEORGIA UNIFORM CERTIFICATIO PROGRAM Section 1: CERTIFICATION INFORMATION

GEORGIA UNIFORM CERTIFICATIO PROGRAM Section 1: CERTIFICATION INFORMATION GEORGIA UNIFORM CERTIFICATIO PROGRAM Section 1: CERTIFICATION INFORMATION A. Prior/Other Certifications Is your firm currently certified for DBE any of the following programs? (If Yes, check appropriate

More information

APPLICATION for NATIONAL CERTIFICATION as a VETERAN BUSINESS ENTERPRISE

APPLICATION for NATIONAL CERTIFICATION as a VETERAN BUSINESS ENTERPRISE APPLICATION for NATIONAL CERTIFICATION as a VETERAN BUSINESS ENTERPRISE APPLICATION FOR NATIONAL CERTIFICATION AS A VETERAN OWNED AND CONTROLLED BUSINESS Introduction We welcome your interest in NWBOC

More information

New York City School Construction Authority APPLICATION FOR. Minority/Woman Business Enterprise (M/WBE) CERTIFICATION

New York City School Construction Authority APPLICATION FOR. Minority/Woman Business Enterprise (M/WBE) CERTIFICATION New York City School Construction Authority APPLICATION FOR Minority/Woman Business Enterprise (M/WBE) CERTIFICATION APPENDI E(4) DOCUMENT CHECKLIST AND INSTRUCTIONS Supplier Only M/WBE Certification is

More information

APPLICATION for NATIONAL CERTIFICATION as a WOSB/EDWOSB

APPLICATION for NATIONAL CERTIFICATION as a WOSB/EDWOSB APPLICATION for NATIONAL CERTIFICATION as a WOSB/EDWOSB (Woman Owned Small Business or Economically Disadvantaged Woman Owned Small Business) Instructions for downloading this WBE application: 1. If you

More information

The City of Burlington Minority and Women Enterprise Program Self-Certification Application

The City of Burlington Minority and Women Enterprise Program Self-Certification Application The City of Burlington Minority and Women Enterprise Program Self-Certification Application Trade name of small business concern Street address of business Mailing address of business (if different) City

More information

City & County of Denver Division of Small Business Opportunity (DSBO)

City & County of Denver Division of Small Business Opportunity (DSBO) City & County of Denver Division of Small Business Opportunity (DSBO) Renewal Application Disadvantaged Business Enterprise (DBE) (3 Year Renewal) (No Fee) Airport Concession Disadvantaged Business Enterprise

More information

FINANCING PROGRAMS APPLICATION

FINANCING PROGRAMS APPLICATION FINANCING PROGRAMS APPLICATION Dated: June 20, 2011 The Business Consortium Fund, Inc. 305 Seventh Avenue, 20 th Floor New York, NY 10001 Attn: Financing Programs Tel: 212-243-7360 Fax: 212-243-7647 info@bcfcapital.com

More information

APPLICATION for NATIONAL CERTIFICATION as a WOMEN BUSINESS ENTERPRISE

APPLICATION for NATIONAL CERTIFICATION as a WOMEN BUSINESS ENTERPRISE APPLICATION for NATIONAL CERTIFICATION as a WOMEN BUSINESS ENTERPRISE Instructions for downloading this WBE application: 1. If you are reading this, then you have successfully opened this application from

More information

SMALL BUSINESS ENTERPRISE NEW PROGRAM APPLICATION CUYAHOGA COUNTY OF OHIO

SMALL BUSINESS ENTERPRISE NEW PROGRAM APPLICATION CUYAHOGA COUNTY OF OHIO SMALL BUSINESS ENTERPRISE NEW PROGRAM APPLICATION CUYAHOGA COUNTY OF OHIO Office of Procurement and Diversity Rev. 09/14 1 IMPORTANT INFORMATION FOR APPLICANT Cuyahoga County certifies Small Business Enterprises

More information

New Jersey Meadowlands Commission Business Accelerator

New Jersey Meadowlands Commission Business Accelerator New Jersey Meadowlands Commission Business Accelerator UNIFORM PROGRAM APPLICATION General Instructions: (Please type or print clearly. Do not leave any spaces blank on the application.) If a question

More information

MWSBE/PDBE Certification Program Information and Application

MWSBE/PDBE Certification Program Information and Application Minority/Women/Small/Persons with Disabilities Business Enterprises (MWSBE and PDBE) Certification Application MWSBE/PDBE Certification Program Information and Application Mission Statement: The Office

More information

Owner Eligibility Requirements are the same for all business structures. One document must be a photo I.D. for identity verification purposes.

Owner Eligibility Requirements are the same for all business structures. One document must be a photo I.D. for identity verification purposes. Documentation Required for WBENC WBE Certification Please provide all documents listed. If a document is not being submitted, please provide an explanation detailing the reason(s) it is being omitted and/or

More information

Small Business Enterprises (SBE) Certification Application

Small Business Enterprises (SBE) Certification Application Small Business Enterprises (SBE) SBE Certification Program Information and Application Mission Statement: The Office of Business Opportunity is committed to creating a competitive and diverse Business

More information

Important! Please read carefully before beginning your Standard Verification application.

Important! Please read carefully before beginning your Standard Verification application. Important! Please read carefully before beginning your Standard Verification application. 1. Please make sure you have selected the right application type. The Standard Verification Application is for

More information

Tribal Employment Rights Office -Pacific Northwest Region-

Tribal Employment Rights Office -Pacific Northwest Region- Tribal Employment Rights Office -Pacific Northwest Region- Native American Business TO THE APPLICANT: This application is for certification of a majority or wholly-owned Native American business interested

More information

Orange County Business Development Division

Orange County Business Development Division Orange County Business Development Division Minority/Women Business Enterprise (M/WBE) Certification Application General Instructions 1. This application will be reviewed in accordance with the Florida

More information

City of Milwaukee Office of Small Business Development. Minority, Woman & Small Business Enterprise Certification Application

City of Milwaukee Office of Small Business Development. Minority, Woman & Small Business Enterprise Certification Application City of ilwaukee Office of Small Business Development inority, Woman & Small Business Enterprise Certification Application City of ilwaukee Department of Administration Business Operations Division Office

More information

PROCEDURES FOR CERTIFICATION with the City of Tulsa Human Rights Department BUILDING RESOURCES IN DEVELOPING and GROWING ENTERPRISE (BRIDGE)

PROCEDURES FOR CERTIFICATION with the City of Tulsa Human Rights Department BUILDING RESOURCES IN DEVELOPING and GROWING ENTERPRISE (BRIDGE) PROCEDURES FOR CERTIFICATION with the City of Tulsa Human Rights Department BUILDING RESOURCES IN DEVELOPING and GROWING ENTERPRISE (BRIDGE) Those firms desiring to be certified as a BRIDGE participant

More information

Fitzgerald Murraine. Enclosures. RE: Certification as SDBE, MBE, FBE and DLSB in the New PEP. Dear Business Owner:

Fitzgerald Murraine. Enclosures. RE: Certification as SDBE, MBE, FBE and DLSB in the New PEP. Dear Business Owner: Robert C. Walker Chairperson Thomas J. Wahlrab Executive Director C I T Y o f D A Y T O N, O H I O HUMAN RE L AT IO NS CO UNCIL 371 West Second Street, Suite 100, Dayton, OH 45402-1417 (937) 333-1405 /

More information

Native American Business APPLICATION FOR CERTIFICATION

Native American Business APPLICATION FOR CERTIFICATION Confederated Tribes of the Grand Ronde Tribal Employment Rights Office Native American Business APPLICATION FOR CERTIFICATION This application is for certification of a majority or wholly- owned Grand

More information

Rule 14-79.006, F.A.C. 275-030-071 EQUAL OPPORTUNITY 06/10 Page 1 of 10 STATE OF FLORIDA. Mail Completed Forms To:

Rule 14-79.006, F.A.C. 275-030-071 EQUAL OPPORTUNITY 06/10 Page 1 of 10 STATE OF FLORIDA. Mail Completed Forms To: Page 1 of 10 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION TALLAHASSEE, FLORIDA APPLICATION FOR SMALL BUSINESS CERTIFICATION (SBC) Mail Completed Forms To: FAMU 2035 East Paul Dirac Drive Suite 130, Morgan

More information

State of Delaware. Office of Supplier Diversity Certification Application. Complete application and mail, email or fax to:

State of Delaware. Office of Supplier Diversity Certification Application. Complete application and mail, email or fax to: State of Delaware Office of Supplier Diversity Certification Application Complete application and mail, email or fax to: Office of Supplier Diversity (OSD) 100 Enterprise Place, Suite 4 Dover, DE 19904-8202

More information

Southeastern Pennsylvania Transportation Authority

Southeastern Pennsylvania Transportation Authority Southeastern Pennsylvania Transportation Authority DBE Program Office Business Services Division Small Business Enterprise Verification Application 49 C.F.R. Part 26 All firms wishing to verify its status

More information

N J DEPARTMENT OF BANKING AND INSURANCE LICENSING SERVICES BUREAU P.O. BOX 473 TRENTON, NJ 08625

N J DEPARTMENT OF BANKING AND INSURANCE LICENSING SERVICES BUREAU P.O. BOX 473 TRENTON, NJ 08625 N J DEPARTMENT OF BANKING AND INSURANCE LICENSING SERVICES BUREAU P.O. BOX 473 TRENTON, NJ 08625 LICENSE APPLICATION INSTRUCTIONS NEW JERSEY IN-STATE OFFICE LOCATION REQUIRED All applications submitted

More information

Office of Business Diversity and Civil Rights

Office of Business Diversity and Civil Rights Office of Business Diversity and Civil Rights Small Business Enterprise Verification Application 49 C.F.R. Part 26 All firms wishing to verify its status as a Small Business Enterprise (SBE) must complete

More information

1 of 16 100 West Randolph St Ste. 4-400, Chicago, IL 60601 Printed on Recycled Paper Revised 01/11

1 of 16 100 West Randolph St Ste. 4-400, Chicago, IL 60601 Printed on Recycled Paper Revised 01/11 RETURN TO: Illinois Department of Central Management Services Business Enterprise Program 100 West Randolph Suite 4-400 Chicago, Illinois 60601 SCHEDULE A Intake Date: Date Assigned: Assigned To: Approval

More information

Certification Application

Certification Application Certification Application US Pan Asian American Chamber of Commerce Education Foundation (USPAACC) 1329 18 th St. NW, Washington DC 20036 Washington DC National Capital Area California Georgia Illinois

More information

Residential Builders New Application

Residential Builders New Application State of Arkansas CONTRACTORS LICENSING BOARD Residential Builders New Application $100.00 Filing Fee - NON-REFUNDABLE MAIL TO: CONTRACTORS LICENSING BOARD 4100 RICHARDS ROAD NORTH LITTLE ROCK, ARKANSAS

More information

2. List of ALL business names under which the corporation, LLC, or LLP provides services.

2. List of ALL business names under which the corporation, LLC, or LLP provides services. State of Alaska Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing Board of Registration for Architects, Engineers and Land Surveyors

More information

SUPPLIER CLEARINGHOUSE REVERIFICATION APPLICATION FORM. Do Not Use This Form Unless Previously Verified by the Clearinghouse

SUPPLIER CLEARINGHOUSE REVERIFICATION APPLICATION FORM. Do Not Use This Form Unless Previously Verified by the Clearinghouse SUPPLIER CLEARINGHOUSE REVERIFICATION APPLICATION FORM For free assistance, please call the Clearinghouse: San Francisco (415) 928-6892 Toll Free: (800) 359-7998 Do Not Use This Form Unless Previously

More information

SAN FRANCISCO COMMUNITY COLLEGE DISTRICT SMALL LOCAL BUSINESS ENTERPRISE RE-CERTIFICATION APPLICATION

SAN FRANCISCO COMMUNITY COLLEGE DISTRICT SMALL LOCAL BUSINESS ENTERPRISE RE-CERTIFICATION APPLICATION SAN FRANCISCO COMMUNITY COLLEGE DISTRICT SMALL LOCAL BUSINESS ENTERPRISE RE-CERTIFICATION APPLICATION Eligible California businesses can be certified as Small Business Enterprise (SBE) or Small Local Business

More information

LOAN PACKAGE REQUIREMENTS

LOAN PACKAGE REQUIREMENTS Thank you for requesting an application for a Burlington County Small Business loan. The Burlington County Small Business Loan Program is for businesses located in or relocating to Burlington County. This

More information

SAN FRANCISCO COMMUNITY COLLEGE DISTRICT SMALL BUSINESS AND SMALL LOCAL BUSINESS ENTERPRISE CERTIFICATION APPLICATION

SAN FRANCISCO COMMUNITY COLLEGE DISTRICT SMALL BUSINESS AND SMALL LOCAL BUSINESS ENTERPRISE CERTIFICATION APPLICATION SAN FRANCISCO COMMUNITY COLLEGE DISTRICT SMALL BUSINESS AND SMALL LOCAL BUSINESS ENTERPRISE CERTIFICATION APPLICATION Eligible California businesses can be certified as Small Business Enterprise (SBE)

More information

VIRGINIA SMALL BUSINESS FINANCING AUTHORITY LOAN GUARANTY PROGRAM. Application Instructions

VIRGINIA SMALL BUSINESS FINANCING AUTHORITY LOAN GUARANTY PROGRAM. Application Instructions VIRGINIA SMALL BUSINESS FINANCING AUTHORITY LOAN GUARANTY PROGRAM Application Instructions GENERAL INFORMATION: The Virginia Small Business Financing Authority's (VSBFA) Loan Guaranty Program is designed

More information

Small Business Enterprise Certification Application 49 CFR Part 26

Small Business Enterprise Certification Application 49 CFR Part 26 Small Business Enterprise Certification Application 49 CFR Part 26 All firms wishing to be certified as a Small Business Enterprise (SBE) must complete this application and submit it to the Washington

More information

RE CERTIFICATION FOR TIER I EMERGING SMALL BUSINESS (ESB) OR SMALL BUSINESS (SB)

RE CERTIFICATION FOR TIER I EMERGING SMALL BUSINESS (ESB) OR SMALL BUSINESS (SB) City of Omaha Jean Stothert, Mayor Human Rights and Relations Department Omaha/Douglas Civic Center 1819 Farnam Street, Suite 502 Omaha, Nebraska 68183 0502 Phone No. (402) 444 5055 Fax (402) 444 5058

More information

RLF LOAN APPLICATION

RLF LOAN APPLICATION 222 N. 32 nd Street, Suite 200 Billings, MT 59101 Phone (406) 869-8403 Fax (406) 256-6877 www.bigskyeda-edc.org RLF LOAN APPLICATION Operating Company Company Address City Zip Principal in charge Work

More information

OMB No.: 3048-0003 Expires February 29, 2004 (Ex-Im Bank Use Only) Date Received

OMB No.: 3048-0003 Expires February 29, 2004 (Ex-Im Bank Use Only) Date Received (SBA Use Only) Date Received C.I.D. No. U.S. SMALL BUSINESS ADMINISTRATION EXPORT-IMPORT BANK OF THE UNITED STATES OMB No.: 3048-0003 (Ex-Im Bank Use Only) Date Received Intermediary JOINT APPLICATION

More information

Instructions to Apply for Registration as a Health Care Services Firm (N.J.A.C. 13:45B-13.3)

Instructions to Apply for Registration as a Health Care Services Firm (N.J.A.C. 13:45B-13.3) New Jersey Office of the Attorney General Division of Consumer Affairs Office of Consumer Protection Regulated Business Section 124 Halsey Street, 7th Floor, P.O. Box 45028 Newark, NJ 07101 (973) 504-6370

More information

Clayton County Central Services 7994 North McDonough Street Jonesboro, Georgia 30236 Phone: (770) 477-3587 Fax: (770) 477-3335

Clayton County Central Services 7994 North McDonough Street Jonesboro, Georgia 30236 Phone: (770) 477-3587 Fax: (770) 477-3335 Clayton County Central Services 7994 North McDonough Street Jonesboro, Georgia 30236 Phone: (770) 477-3587 Fax: (770) 477-3335 CONTRACT COMPLIANCE DIVISION CENTRAL SERVICES DEPARTMENT MINORITY AND WOMAN-OWNED

More information

PENN STATE FEDERAL BUSINESS LOAN APPLICATION

PENN STATE FEDERAL BUSINESS LOAN APPLICATION PENN STATE FEDERAL BUSINESS LOAN APPLICATION Date: Branch: Office: BUSINESS LOAN APPLICATION CHECKLIST Please be sure to include all of the following so that we may process your application as quickly

More information

MUSKEGON COUNTY UNIFIED CERTIFICATION APPLICATION FOR DISADVANTAGED, MINORITY AND WOMEN-OWNED BUSINESS ENTERPRISES

MUSKEGON COUNTY UNIFIED CERTIFICATION APPLICATION FOR DISADVANTAGED, MINORITY AND WOMEN-OWNED BUSINESS ENTERPRISES MUSKEGON COUNTY UNIFIED CERTIFICATION APPLICATION FOR DISADVANTAGED, MINORITY AND WOMEN-OWNED BUSINESS ENTERPRISES APPLICATION FEE $25 May 2003 Last revised 2/25/04 MAY 2003 MUSKEGON COUNTY UNIFIED CERTIFICATION

More information

APPLICATION FOR FINANCIAL ASSISTANCE Phone: 513.631.8292 Fax: 513.631.1192 1776 Mentor Ave. Suite 100 Cincinnati, OH 45212 www.hcdc.

APPLICATION FOR FINANCIAL ASSISTANCE Phone: 513.631.8292 Fax: 513.631.1192 1776 Mentor Ave. Suite 100 Cincinnati, OH 45212 www.hcdc. APPLICATION FOR FINANCIAL ASSISTANCE Phone: 513.631.8292 Fax: 513.631.1192 1776 Mentor Ave. Suite 100 Cincinnati, OH 45212 www.hcdc.com COMPANY INFORMATION: (This is information about your operating business.)

More information

Standard Operating Procedures (SOP): e.

Standard Operating Procedures (SOP):  e. 8(a) APPLICATION CHECKLIST In order to make screening easier and expedite the review process, please submit the 8(a) application in the order as reflected below. DO NOT use tabs, plastic sleeves, dividers,

More information

Application for 8(a) Business Development (8(a) BD) and Small Disadvantaged Business (SDB) Certification

Application for 8(a) Business Development (8(a) BD) and Small Disadvantaged Business (SDB) Certification Application for 8(a) Business Development (8(a) BD) and Small Disadvantaged Business (SDB) Certification OMB Approval:3245-0331 Expiration : 8/31/2007 To be completed by SBA Received To be completed by

More information

SUBMISSION CHECKLIST CONTRACT BONDS

SUBMISSION CHECKLIST CONTRACT BONDS 4446 State Route 42, Ste. B Monticello, NY 12701 T (845) 791-6700 / F (845) 794-5333 www.hudsonunderwriters.com SUBMISSION CHECKLIST CONTRACT BONDS We appreciate this opportunity to earn your business.

More information

12 Business Information (Green Sheet)

12 Business Information (Green Sheet) Give us COPIES only Clips only - NO STAPLES 12 Business Information (Green Sheet) If you are self-employed, or if you have had income for which you do not receive a W-2, please provide the following: A.

More information

CITADEL BUSI ESS ACCOU T / BUSI ESS LOA APPLICATIO

CITADEL BUSI ESS ACCOU T / BUSI ESS LOA APPLICATIO CITADEL BUSI ESS ACCOU T / BUSI ESS LOA APPLICATIO Part 1 - Business Information Account Number Date Business Established: State of Incorporation/ Organization: Type of Entity: Individual/ Sole Proprietorship

More information

DISADVANTAGED BUSINESS ENTERPRISE PROGRAM 49 CFR PART 26 UNIFIED CERTIFICATION APPLICATION

DISADVANTAGED BUSINESS ENTERPRISE PROGRAM 49 CFR PART 26 UNIFIED CERTIFICATION APPLICATION DISADVANTAGED BUSINESS ENTERPRISE PROGRAM 49 CFR PART 26 UNIFIED CERTIFICATION APPLICATION ROADMAP FOR APPLICANTS 1 Should I apply? o Is your firm at least 51%-owned by a socially and economically disadvantaged

More information

advice backed by our knowledge and experience Delta Community Credit Union Business Services distinguished by

advice backed by our knowledge and experience Delta Community Credit Union Business Services distinguished by Delta Community Credit Union is a financial institution with over $3.3 billion in assets. Delta Community Credit Union Business Services distinguished by We are a cooperative, owned and operated by our

More information

PLEASE RETAIN COPIES OF ALL DOCUMENTS FOR YOUR RECORDS.

PLEASE RETAIN COPIES OF ALL DOCUMENTS FOR YOUR RECORDS. Real Estate / SBA Loan Checklist Ownership Information Completed Credit Application Completed Personal Financial Statement (for each owner) 3 Years Personal Federal Tax Returns (for each owner) Management

More information

INNOVATION FUND Loan Application

INNOVATION FUND Loan Application INNOVATION FUND Loan Application Department of Development 500 E. Main Street, Suite 1500, Norfolk, VA 23510 Phone: (757-664-4338 Fax: 757-441-2910 CREDIT REQUEST Amount Requested: Term Requested (# months):

More information

BUSINESS LOAN APPLICATION

BUSINESS LOAN APPLICATION BUSINESS LOAN APPLICATION New Relationship Existing Relationship Branch: Officer: BUSINESS INFORMATION Business Name Tax I.D. Individual Name(s) Social Security # Date of Birth: Proprietorship Partnership

More information

SMALL BUSINESS MOBILIZATION LOAN APPLICATION

SMALL BUSINESS MOBILIZATION LOAN APPLICATION SMALL BUSINESS MOBILIZATION LOAN APPLICATION All applicants must complete the Application in its entirety. The Guidelines section contains information on the Loan Program Parameters, the Loan Applications

More information

APPLICATION FOR ASSIGNMENT, SALE, TRANSFER OR CHANGE OF OWNERSHIP STRUCTURE OF EXISTING PRIVATE CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY

APPLICATION FOR ASSIGNMENT, SALE, TRANSFER OR CHANGE OF OWNERSHIP STRUCTURE OF EXISTING PRIVATE CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY OFFICE OF AMBULANCE REGULATION COORDINATION 140 WEST FLAGLER STREET SUITE 904 MIAMI, FLORIDA 33130-1561 Tel: (305) 375-5801 Fax: (305) 372-6321 E-mail: consumer@miamidade.gov APPLICATION FOR ASSIGNMENT,

More information

Business Loan Application

Business Loan Application Business Loan Application For LDC Staff Use Application received on: by Loan Program (s): 7/2015 BUSINESS INFORMATION Business Name: (Proposed or Existing) Loan Amount: $ Business Address: City County

More information

HOW TO OBTAIN A NEW CONTRACTOR LICENSE

HOW TO OBTAIN A NEW CONTRACTOR LICENSE HOW TO OBTAIN A NEW CONTRACTOR LICENSE These instructions apply to new licenses only. If you wish to add a classification or a qualifying party to an existing license, please see HOW TO ADD A CLASSIFICATION

More information

VIDEO GAMING TERMINAL COLLATERAL LENDER REGISTRATION FORM (Pursuant to Video Gaming Adopted Rule 1800.930)

VIDEO GAMING TERMINAL COLLATERAL LENDER REGISTRATION FORM (Pursuant to Video Gaming Adopted Rule 1800.930) ILLINOIS GAMING BOARD 160 North LaSalle Street, 3 rd Floor Chicago, Illinois 60601 312-814-4700 VIDEO GAMING TERMINAL COLLATERAL LENDER REGISTRATION FORM (Pursuant to Video Gaming Adopted Rule 1800.930)

More information

PATHSTONE ENTERPRISE CENTER, INC. Small Business Loan Application

PATHSTONE ENTERPRISE CENTER, INC. Small Business Loan Application PATHSTONE ENTERPRISE CENTER, INC. Small Business Loan Application PathStone Enterprise Center, Inc. 400 East Ave. Rochester, NY 14607 Phone: (585) 340-3705 Fax: (585) 340-3326 TDD: 800-545-1833 Web Site:

More information

CITADEL BUSI ESS ACCOU T / BUSI ESS LOA APPLICATIO

CITADEL BUSI ESS ACCOU T / BUSI ESS LOA APPLICATIO CITADEL BUSI ESS ACCOU T / BUSI ESS LOA APPLICATIO Part 1 - Business Information Account Number Date Business Established: State of Incorporation/ Organization: Type of Entity: Individual/ Sole Proprietorship

More information

STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVERSIGHT

STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVERSIGHT STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVERSIGHT INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR A LICENSE UNDER THE CALIFORNIA FINANCE LENDERS LAW (CFLL) WHO IS REQUIRED TO OBTAIN A FINANCE LENDERS

More information

CITY OF JACKSON, MISSISSIPPI MINORITY/WOMEN BUSINESS ENTERPRISE DISCLOSURE AFFIDAVIT

CITY OF JACKSON, MISSISSIPPI MINORITY/WOMEN BUSINESS ENTERPRISE DISCLOSURE AFFIDAVIT CITY OF JACKSON, MISSISSIPPI MINORITY/WOMEN BUSINESS ENTERPRISE DISCLOSURE AFFIDAVIT In order to evaluate the legitimacy of each MBE/FBE applicant, certain relevant information must be provided initially,

More information

UNIFIED CERTIFICATION PROGRAMS MBE/WBE/DBE CERTIFICATION UNIFIED CERTIFICATION APPLICATION

UNIFIED CERTIFICATION PROGRAMS MBE/WBE/DBE CERTIFICATION UNIFIED CERTIFICATION APPLICATION UNIFIED CERTIFICATION PROGRAMS MBE/WBE/DBE CERTIFICATION UNIFIED CERTIFICATION APPLICATION General Instructions: (PLEASE TYPE OR PRINT CLEARLY. DO NOT LEAVE ANY SPACES BLANK ON THE APPLICATION.) If a question

More information

WONG GLOBEWIDE PROPERTY INVESTMENTS CORPORATION WGPIC. Commercial Loan Application. Need Help! Please call 213-618-6611 Ask for JC

WONG GLOBEWIDE PROPERTY INVESTMENTS CORPORATION WGPIC. Commercial Loan Application. Need Help! Please call 213-618-6611 Ask for JC WONG GLOBEWIDE PROPERTY INVESTMENTS CORPORATION WGPIC Commercial Loan Application Need Help! Please call 213-618-6611 Ask for JC Or Efax 866-612-9898 Or Email: Info@WGPIC.com (please answer all questionnaires

More information

Proper Procedures to Make Business Permit Changes

Proper Procedures to Make Business Permit Changes Proper Procedures to Make Business Permit Changes Board approval to make changes to a business permit depends upon: A properly completed Application to Make Business Permit Changes accompanied by the appropriate

More information

LIABILITIES. Cash on Hand and in Banks $ Outstanding Bills $ Savings Accounts $ Notes Payable to Banks and Others $

LIABILITIES. Cash on Hand and in Banks $ Outstanding Bills $ Savings Accounts $ Notes Payable to Banks and Others $ Small Business Loan Pool Application Page 1 of 5 (Rev. August 2010) Date: 5 AND 10 SMALL B USINESS L OAN F UND ECONOMIC DEVELOPMENT AUTHORITY OF FLOYD COUNTY SECTION I: GENERAL INFORMATION REQUEST FOR

More information

PLEASE DO NOT BIND THE APPLICATION OR DOCUMENTS: USE A LOOSE LEAF BINDER, PREFERABLY.

PLEASE DO NOT BIND THE APPLICATION OR DOCUMENTS: USE A LOOSE LEAF BINDER, PREFERABLY. MINORITY BUSINESS ENTERPRISE COUNCIL Municipal Services Building 1401 John F. Kennedy Boulevard, Room 330 Philadelphia, PA 19102 Telephone: (215) 686-MBEC Fax: (215) 686-3878 Dear Applicant: The Minority

More information

CITY OF CHARLOTTE SMALL BUSINESS ENTERPRISE CERTIFICATION APPLICATION

CITY OF CHARLOTTE SMALL BUSINESS ENTERPRISE CERTIFICATION APPLICATION CITY OF CHARLOTTE SMALL BUSINESS ENTERPRISE CERTIFICATION APPLICATION City of Charlotte Neighborhood & Business Services Charlotte Business INClusion c/o Certification Services 600 East Trade Street, Suite

More information

CHEROKEE COUNTY. Entrepreneurship (E-) Community Loan Application

CHEROKEE COUNTY. Entrepreneurship (E-) Community Loan Application CHEROKEE COUNTY Entrepreneurship (E-) Community Loan Application January 2015 Cherokee County E-Community Program A partnership project of Cherokee County Economic Development Corporation 104 S. Kansas

More information

Performance and Payment Bonds

Performance and Payment Bonds Performance and Payment Bonds Submission Requirements 1) Request for Performance and Payment Bonds. (Forms attached for your convenience, please return only with a Performance and or Payment Bond Request.

More information

CONTRACT BOND SUBMISSION CHECKLIST

CONTRACT BOND SUBMISSION CHECKLIST CONTRACT BOND SUBMISSION CHECKLIST Contractors uestionnaire Bond equest orm Copy of contract (if final bond request) Past three years CPA Prepared fiscal year end statements Interim financial statement

More information

BUSINESS LOAN APPLICATION

BUSINESS LOAN APPLICATION BUSINESS LOAN APPLICATION One Commerce Park P. O. Box 160 Shallowater,Texas 79363 Phone - 806.832.4525 Fax - 806.832.5849 EMAIL ADDRESS - MARK@FSBSHALLOWATER.COM Page 9 of 23 Commercial Loan Application:

More information

Company New Application Checklist Jurisdiction-Specific Requirements

Company New Application Checklist Jurisdiction-Specific Requirements Company New Application Checklist Jurisdiction-Specific Requirements MA MASSACHUSETTS DEBT COLLECTOR LICENSE This document includes instructions for a company (corporation location) new application request.

More information

CITY OF WARREN REVOLVING LOAN FUNDS

CITY OF WARREN REVOLVING LOAN FUNDS T hank you for asking about the City of Warren Revolving Loan Funds. We are pleased that you are taking the initiative to open or expand your business. Owning a business takes dedication, hard work and

More information

APPLICATION FOR BUSINESS LICENSE INCLUDING SALES AND USE TAX AND OCCUPATIONAL PRIVILEGE TAX REGISTRATION

APPLICATION FOR BUSINESS LICENSE INCLUDING SALES AND USE TAX AND OCCUPATIONAL PRIVILEGE TAX REGISTRATION City of Aurora Tax and Licensing 15151 E. Alameda Parkway, Suite 1100 Aurora, CO 80012 (303) 739-7057 www.auroragov.org REGISTRATION/LICENSE FEE: $49.25 PAYABLE TO CITY OF AURORA Special licenses may require

More information

Corporation, a copy of the file stamped Articles or Certificate of Incorporation

Corporation, a copy of the file stamped Articles or Certificate of Incorporation Thank you for choosing Frost for your business credit needs. We are committed to helping you determine the best financing option for your business. To assist us, we ask that you complete and submit the

More information

7A Loan Application. Conestoga Bank. Company Information. Company Ownership. Affiliate Businesses. Existing Business Locations. Management Background

7A Loan Application. Conestoga Bank. Company Information. Company Ownership. Affiliate Businesses. Existing Business Locations. Management Background Conestoga Bank 7A Loan Application Company Information Company name Address City State Zip Principal in charge Phone Fax Secondary contact person Phone Fax (IN-HOUSE CONTROLLER OR BOOKEEPER) Type of business

More information

VENDOR PROFILE AND CONSTRUCTION PREQUALIFICATION FORM

VENDOR PROFILE AND CONSTRUCTION PREQUALIFICATION FORM VENDOR PROFILE AND CONSTRUCTION PREQUALIFICATION FORM TO: INQUIRING VENDORS RE: VENDOR PROFILE AND PREQUALIFICATION FORM Thank you for your interest into business opportunities with Henry Ford Health System.

More information

Documents Required. $400 due diligence check per company made payable to Capstone Business Funding, LLC

Documents Required. $400 due diligence check per company made payable to Capstone Business Funding, LLC Legal Business Name Date Documents Required Current Accounts Receivable Aging Report Company Information Application and Origination Statement (Have your signature notarized under Origination Statement

More information

Instructions For: Tampa-Hillsborough Unified Application Minority and Small (Local) Business Enterprise Certification/Registration

Instructions For: Tampa-Hillsborough Unified Application Minority and Small (Local) Business Enterprise Certification/Registration Instructions For: Tampa-Hillsborough Unified Application Minority and Small (Local) Business Enterprise Certification/Registration www.tampagov.net/mbd http://www.hillsboroughcounty.org Hillsborough County

More information

Emerald Financial Commercial Funding COMMERCIAL LOAN APPLICATION

Emerald Financial Commercial Funding COMMERCIAL LOAN APPLICATION Emerald Financial Commercial Funding COMMERCIAL LOAN APPLICATION This checklist if provided to assist in gathering the necessary information needed for the initial evaluation of your loan request. Complete

More information

Commercial Loan Application. Personal Financial Statement. Certification of Personal Financial Statement

Commercial Loan Application. Personal Financial Statement. Certification of Personal Financial Statement Thank you for your interest in pursuing financing with Valley National Bank. In order to begin the analysis of your credit request, please complete the following: Commercial Loan Application Personal Financial

More information

RESIDENTIAL REHABILITATION PROGRAM

RESIDENTIAL REHABILITATION PROGRAM City of North Lauderdale COMMUNITY DEVELOPMENT DEPARTMENT 701 S.W. 71 st Avenue North Lauderdale, Florida 33068 Telephone: (954) 724-7065 Fax: (954) 720-2064 RESIDENTIAL REHABILITATION PROGRAM If you are

More information

OFFICE OF INSURANCE REGULATION Company Admissions

OFFICE OF INSURANCE REGULATION Company Admissions OFFICE OF INSURANCE REGULATION Company Admissions APPLICATION FOR LICENSE This package is designed to assist individuals in preparing the application with all the information required by statute and to

More information

CONTRACT BONDS * Bid * Payment * Performance

CONTRACT BONDS * Bid * Payment * Performance ALAMO SURETY BONDS Phone (210) 930-5550 2361 Austin Hwy Fax (210) 930-3255 San Antonio, TX 78218 bondinfo@alamobonds.com To qualify for bonding credit, the surety company underwriter will need to determine

More information

BEFORE THE NORTH CAROLINA UTILITIES COMMISSION RALEIGH, NORTH CAROLINA

BEFORE THE NORTH CAROLINA UTILITIES COMMISSION RALEIGH, NORTH CAROLINA BEFORE THE NORTH CAROLINA UTILITIES COMMISSION RALEIGH, NORTH CAROLINA NCUC Form CE-2 (Revised April 2013) APPLICATION TO SELL, ASSIGN, PLEDGE, TRANSFER, LEASE, MERGE, OR ACQUIRE EXISTING CERTIFICATE OF

More information

DEPARTMENT OF COMMERCE DIVISION OF FINANCIAL INSTITUTIONS

DEPARTMENT OF COMMERCE DIVISION OF FINANCIAL INSTITUTIONS STATE OF MINNESOTA DEPARTMENT OF COMMERCE DIVISION OF FINANCIAL INSTITUTIONS RE: CONSUMER SMALL LOAN LENDER ACT Application may be made on the attached forms for a Consumer Small Loan Lending license pursuant

More information

10. PROOF OF USABLE PHONE listed with local directory assistance in the business name and lot address as it appears on the initial application.

10. PROOF OF USABLE PHONE listed with local directory assistance in the business name and lot address as it appears on the initial application. USED MOTOR VEHICLE AND PARTS COMMISSION 2401 NW 23 rd, Suite 57, Oklahoma City, OK 73107 Phone: (405)521-3600 Fax (405)521-3604 www.usedcarcommission.ok.gov WHOLESALE MOTOR VEHICLE DEALER S LICENSE INSTRUCTION

More information

BEFORE THE NORTH CAROLINA UTILITIES COMMISSION RALEIGH, NORTH CAROLINA APPLICATION FOR CERTIFICATE OF EXEMPTION TO TRANSPORT HOUSEHOLD GOODS

BEFORE THE NORTH CAROLINA UTILITIES COMMISSION RALEIGH, NORTH CAROLINA APPLICATION FOR CERTIFICATE OF EXEMPTION TO TRANSPORT HOUSEHOLD GOODS BEFORE THE NORTH CAROLINA UTILITIES COMMISSION RALEIGH, NORTH CAROLINA APPLICATION FOR CERTIFICATE OF EXEMPTION TO TRANSPORT HOUSEHOLD GOODS Form CE-1 (Revised June 2009) Docket No. Name of Applicant and/or

More information

SCRANTON, PA 18503 (570) 963-6800

SCRANTON, PA 18503 (570) 963-6800 REQUEST FOR PROPOSALS FOR GRANT WRITING SERVICES FOR ENVIRONMENTAL ASSESSMENTS OF BROWNFIELD SITES PROPOSAL FORMAT AND SCOPE OF SERVICES PROPOSALS TO BE SUBMITTED BY 10:00 AM, MONDAY, SEPTEMBER 29, 2014

More information

SBA Loan Checklist. Ownership Information. Site Information (For Real Estate Transactions Only) Business Information

SBA Loan Checklist. Ownership Information. Site Information (For Real Estate Transactions Only) Business Information SBA Loan Checklist Ownership Information Completed Credit Application Completed Personal Financial Statement (for each owner) Summary of Project Cost (form attached) 3 Years Personal Federal Tax Returns

More information

Carmel Unified School District. Prequalification Application For Bleacher and Pressbox Replacement Project at Carmel High School

Carmel Unified School District. Prequalification Application For Bleacher and Pressbox Replacement Project at Carmel High School Carmel Unified School District Prequalification Application For Bleacher and Pressbox Replacement Project at Carmel High School January 4, 2016 1 NOTICE REGARDING PREQUALIFICATION FOR BLEACHER AND PRESSBOX

More information

If you need assistance completing this application, please email us at bdeangelis@coosedc.org

If you need assistance completing this application, please email us at bdeangelis@coosedc.org LOAN APPLICATION Coös Economic Development Corporation (CEDC) CEDC If you need assistance completing this application, please email us at bdeangelis@coosedc.org Part A: BUSINESS INFORMATION REGISTERED

More information

Financial Information Statement for Businesses

Financial Information Statement for Businesses Financial Information Statement for Businesses How to Complete This Statement Enter the most current data available in all spaces. Write N/A in spaces that don t apply to you. The Taxation and Revenue

More information

Business Visa Application

Business Visa Application 3181 Larchmont Avenue NE, Warren, OH 44483-2498 330.372.8100 * 330.726.0344 * 330.539.6627 * 800.775.7741 www.sscu.net : Business Visa Application App ID: Account Number: Section 1. Business Information

More information