LIAACC Procurement Intake Form
Email
*
example@example.com
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Company Name
*
My company is a:
*
Sole Owner
LLC
C-Corp
S-Corp
Sole Owner
None
Other
List your services:
Certification (s)
*
NYC WMBE
NYS WMBE
NY/NJ Port Authority
Nassau County
None
Other
List other Certification and Registration
*
Registration
NYC Vendor
NYS Vendor
NJ Vendor
None
Other
Are you interested in By Black Certification
*
Yes
No
Are you a member of the LIAACC?
*
Yes
No
Are you interested in becoming a member?
*
Yes
No
Submit
Should be Empty: