Name of NMSDC Affiliate Council where company obtained original certification and expiration date:
The undersigned swears that the foregoing statements are true and correct and include all material information necessary to identify and explain the operations of Type a label ,as well as the ownership thereof. Further, the undersigned agrees to provide current, complete and accurate information regarding actual work performed on a project, the payment therefore and any proposed changes, if any, of the foregoing arrangements and to permit the audit and examination of books, records and files of the named firm.I am executing this affidavit, and state that I am properly authorized to execute the affidavit and am doing so as a free act and deed.Furthermore, I understand that:The NY & NJ Minority Supplier Development Council reserves the right to request any additional information that it may deem necessary to substantiate the information and representations made by the applicant(s) for subscription services.The undersigned hereby declares under penalty of perjury that all statements made in this application and any attachments hereto are true and correct. I understand that the Subscription Services Application Fee is included and non-refundable.Signature of all Proprietor, Partners and President of the Corporation
Please allow ten (10) business days for processing.Please retain a copy of this form for your files.