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Minority Owned Business Certification
Application Form
COMPANY PROFILE
(Including Corp. LLC. PLLC. LP. LLP. LLLP. Ltd.)
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(Required for Corp. LLC. PLLC. LP. LLP. LLLP. Ltd.)
FILING NUMBER MUST BE CORRECT
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(Lookup Your NAICS Industry Code)
MANAGEMENT
(% of Ownership Combined Must Total 100%)
COMPANY CONTACT
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Qualifications
Minority Owned Business
Eligible "Socially Disadvantaged Groups" as defined by the Small Business Act:
Black Americans - (African Descent)
Hispanic Americans - Spanish speaking
Hispanic Americans - Portuguese speaking
Native Americans - American Indians
Native Americans - Eskimos
Native Americans - Aleuts
Native Americans - Native Hawaiians
Asian Pacific Americans - Origins of Burma
Asian Pacific Americans - Origins of Thailand
Asian Pacific Americans - Origins of Malaysia
Asian Pacific Americans - Origins of Indonesia
Asian Pacific Americans - Origins of Singapore
Asian Pacific Americans - Origins of Brunei
Asian Pacific Americans - Origins of Japan
Asian Pacific Americans - Origins of China (including Hong Kong)
Asian Pacific Americans - Origins of Taiwan
Asian Pacific Americans - Origins of Laos
Asian Pacific Americans - Origins of Cambodia (Kampuchea)
Asian Pacific Americans - Origins of Vietnam
Asian Pacific Americans - Origins of Korea
Asian Pacific Americans - Origins of The Philippines
Asian Pacific Americans - Origins of U.S.Trust Territory of the Pacific Islands (Republic of Palau)
Asian Pacific Americans - Origins of Republic of the Marshall Islands
Asian Pacific Americans - Origins of Federated States of Micronesia
Asian Pacific Americans - Origins of The Commonwealth of the Northern Mariana Islands
Asian Pacific Americans - Origins of Guam
Asian Pacific Americans - Origins of Samoa
Asian Pacific Americans - Origins of Macao
Asian Pacific Americans - Origins of Fiji
Asian Pacific Americans - Origins of Tonga
Asian Pacific Americans - Origins of Kiribati
Asian Pacific Americans - Origins of Tuvalu
Asian Pacific Americans - Origins of Nauru
Subcontinent Asian Americans - Origins of India
Subcontinent Asian Americans - Origins of Pakistan
Subcontinent Asian Americans - Origins of Bangladesh
Subcontinent Asian Americans - Origins of Sri Lanka
Subcontinent Asian Americans - Origins of Bhutan
Subcontinent Asian Americans - Origins of The Maldives Islands
Subcontinent Asian Americans - Origins of Nepal
I Confirm That I Am Authorized To Submit This Business Certification Application On Behalf Of The Company And Management Listed. I Agree With The
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