1445 MARKET, SUITE 300 :: DENVER, CO 80202 :: Phone 303.623.3037 :: Fax (303) 595-0027
Return to Services / Certification Applications
IMPORTANT REQUIREMENTS: Please fill out the application entirely and submit the company's most recent IRS tax return.
DATE:
1. Company Name:
2. Certificate NO:
3. Parent Company:
4. Business Address:
5. City, State Zip:
6. Mailing Address:
7. City, State Zip:
8. Phone Number:
9. Email Address:
10. Owner's Name:
Fax Number:
Web Address:
12. Other Contact:
Title:
13. Send Mail to:
14. NAIC Code(s):
15. Product/Service Description:
16. Type of Business: Select primary function.
11. Owner's Title:
Owner's Ethnic*:
*White, Black, Asian, Native American, Hispanic
17. NO of Employees:
NO. of Minority Employees:
18. Business Structure:
19. GEO. MKT:
20. Federal Tax Number:
Year Established:
21. Annual Sales:
Annual Sales Year:
22. Other Certifications:
23. References:
Company:
Location:
Company:
Location:
Bank Name:
Location:
PLEASE CHECK ONE BOX ONLY!
I hereby affirm that no changes have taken place in the minority ownership, control or management of my company since last certified.
I hereby attest that changes have taken place in the minority ownership, control or management of my company since last certified.
Owner/Prinicipal Signature:
Date:
Requirements to be submitted within 15 days:
1. Completed application
2. Last two years of tax returns.
3. Non-refundable fee
Please Remember: Any change in ownership, control or management which could affect your certification status and is not reported within 30 days of change will result in your immediate decertification.
All inactive, expired, denied and decertified files will be destroyed in 30 days.
Important: This Recertification Application, required documents and the non-refundable fee must be submitted prior to the expiration date listed on your certificate. If your certificate has expired you will need to start over with the MBE Certification Application and required documents.
The application process takes approximately 90 days.
As a courtesy, The Council will provide a reminder to each certified MBE 60 and 30 days in advance of expiration of certification. HOWEVER, it is ultimately the responsibility of the MBE to maintain current certification.
Fee for MBE Recertification $150.00
To submit your application please click the submit button then proceed to the "Buy This" button. Thank you.
