CMSDC Subscription Services Application

Subscription Services Application

Please answer all questions as completely as possible. If a particular question does not apply to your business operation, write “N/A” (not applicable) in the space provided.
Date of Application*

MonthDayYear
Date
NMSDC affiliate council where company obtained original certification*
Certification Date*

MonthDayYear
Date
Company*
DBA (if applicable)
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Telephone*
Please enter a valid phone number.
Fax
FEIN or Social Security Number*
Website Address
E-mail Address*
example@example.com
Key Contact's Name (preferably owner/principal)*
Key Contact's Title*
In the space below, please give a concise description of your company's product(s) or service(s) as documented by your home council. The description will be placed in our database and online directory.*
NAICS Code(s)*

Owner(s) Information*

*Citizenship Status: 1 = By Birth or 2 = Naturalized Citizen | **Ownership must total 100%
Type of Business (check primary function)*

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

CorporationLimited Liability Company (LLC)Limited Liability Partnership (LLP)General PartnershipSole Proprietorship*
*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.
Date Business Was Established*

MonthDayYear
Date
Does your firm hold 8(a) certification?*

YesNo
Please provide the most current gross receipts of your firm.*
Geographic Market (fill in where applicable). List locations that the firm serves or is capable of serving.*
Provide Three Current Customer References

Please select your company's current annual sales/revenues based on the ranges below:

< $1 million

$300.00

$1 to $10 million

$550.00

$10 to $50 million

$675.00

> $50 million

$875.00

Enter coupon

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