Are you a Black-Owned Business or Minority Owned Business? Name of Person Submitting Form * First Name Last Name Company Name Name of Business Owner(s) * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Contact Email * Business Phone (###) ### #### Mobile Phone (###) ### #### Company Website http:// Diversity Business Classification * Blacked Owned Business Enterprise Minority Business Enterprise Disadvantage Business Enterprise Women Business Enterprise Veteran-owned Small Business Short Description about your Business Thank you for submitting information about these Black-owned and Minority Owned Businesses in our community!
