Subscription Services Application

Subscription Services Application
3 Riverway, Suite 555, Houston, TX 77056 | (713) 271-7805 | info@hmsdc.org | hmsdc.org
Date of Application*

MonthDayYear
Date
Company*
Parent Company, if applicable*
Company Address*

Street Address

Street Address Line 2

CityState

Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

CityState

Zip Code
Company Telephone*
Please enter a valid phone number.
Company Fax Number
Please enter a valid phone number.
Company Website
Owner's Name*
Owner's Title*
Owner's Email Address*
example@example.com
Owner's Phone Number*
Please enter a valid phone number.
Secondary Contact Name
Secondary Contact Title
Secondary Contact Email Address
example@example.com
Secondary Contact Phone Number
Please enter a valid phone number.
In the space below, please give a concise description of company’s product(s), service(s), or type of construction. If your company offers more than one product/service, list primary product or service first. Use additional paper, if necessary, and attach to this form. The description below will be placed in our database and online directory.*
NAICS code(s) separated by commas*
Date Business was Established*

MonthDayYear
Date
What are the gross receipts of your firm for each of the past four years? (if in business less than one year, provide gross receipts to date)*
What are the gross receipts of your firm for each of the past four years? (if in business less than one year, provide gross receipts to date)*
Number of Employees*
Type of Business (check primary function)*

Brokers/Agents (BA)Construction Contractor (CC)Consultant/Professionals (CP)Distributor (DS)Manufacturer (MF)Manufacturer's Rep (MR)Service Contractor (SC)
Type of Legal Business Structure*

Corporation (C)Limited Liability Corporation or Company (LLC)Limited Liability Partnership (LLP)General Partnership (P)Sole Proprietorship (S)*
Geographic Market*

Local (L)Regional (R)National (N)International (I)
*NMSDC’s definition of Sole Proprietorship is a company owned/operated 100% by one (1) individual or married couple. Split ownership does not constitute Sole Proprietorship.
What is your home NMSDC affiliate council?*
Expiration Date*

MonthDayYear
Date

Please list each owner, proprietor, partner, officer, member, director and stockholder. The name listed should include minority group members and non-minority group members. NMSDC does not certify non-citizens. Please put 'N/A' in all unused fields.*

	Name/Title	Ethnic Origin*	Gender	Citizenship	Years of Ownership	Ownership Role	Ownership Percentage (entries must total 100%)	Voting %
1
2
3

Please upload a copy of your certificate*

Cancelof
Fee Structure
Class 1 ($0 - $1M)

$450
Class 2 ($1M - $10M)

$600
Class 3 ($10 - $50M)

$800
Class 4 ($50M+)

$1,000
Signature of all Proprietors, Partners, and President of the Company
Signature*

Clear
Date*

MonthDayYear
Date
Signature

Clear
Date

MonthDayYear
Date
Signature

Clear
Date

MonthDayYear
Date

Subscription Fee*

Class 1 Subscription FeeFor companies that made less than $1M in 2021.

$450.00

Class 2 Subscription FeeFor companies that made between $1M - $9.9M in 2021.

$600.00

Class 3 Subscription FeeFor companies that made between $10M - $49.9M in 2021.

$800.00

Class 4 Subscription FeeFor companies that made greater than $50M in 2021.

$1,000.00

I will be paying by checkPlease make your checks payable to HMSDC. Send your checks to 3 Riverway, Suite 555, Houston, TX 77056

$ Free

Product Name

$ Free Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty: