SEDC Stakeholder Application
Please complete the following information for your SEDC Stakeholder Investment.
Company Information
Company Name
*
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Website
*
Company Logo
*
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of
Industry Category
*
Please Select
Abstract & Title
Accommodations/Travel
Accountants
Attractions
Auto Dealerships/Auto Parts
Builders/Contractors
Building Equipment/Materials Services
Communications Services
Computer Services
Consultants
Developers
Educational Institutions
Engineers/Architects
Environmental Services
Event Services
Financial Institutions
Financial Services
Fuel & Energy Providers
Government Agencies/Officials
Healthcare
Hospitality
Industrial Supply/Services
Insurance
Landscaping/Forest Mgmt.
Legal Services
Local Trades Organizations
Logistics
Manufacturing
Marketing/Advertising
Non-Profit/Not-For-Profit
Office Equipment/Supplies
Office Furniture
Payroll Services
Personnel Services
Photographers
Printing/Graphics
Professional Cleaning Services
Real Estate Agencies/Brokers
Retail
Security Services
Transportation
Utility
Warehouse/Distribution
Waste Removal Services
Please select one.
NAICS Code
*
You can find your code at www.naics.com
Primary Contact
*
First Name
Last Name
Title
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
President/CEO
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Business Development Contact
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Marketing Contact
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Billing Contact
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Please indicate your annual Stakeholder level:
*
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( X )
Founder
$
20,000.00
one-time payment
Benefactor
$
10,000.00
one-time payment
Leadership
$
5,000.00
one-time payment
Executive
$
2,500.00
one-time payment
Associate
$
1,000.00
one-time payment
Supporter
$
500.00
one-time payment
Credit Card
First Name
Last Name
Credit Card Number
Security Code
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
Expiration Year
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Authorized Signature
*
Date
*
-
Month
-
Day
Year
Date
Please verify that you are human
*
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