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Return to Services / Certification Applications



IF YOU ARE ALREADY CERTIFIED BY ANOTHER NATIONAL MINORITY
SUPPLIER DEVELOPMENT COUNCIL (NMSDC) AFFILIATE,
COMPLETE THIS DOCUMENT TO RECEIVE CERTIFICATION FROM RMMSDC.

DO NOT LEAVE ANY ITEMS BLANK OR OMIT ANY REQUESTED DOCUMENTS.
Date
Legal Name of Business
List dba, if any
Street Address
City, State Zip Code
Mailing Address (if different)
City, State Zip Code
Telephone Number
Fax Number
E-mail Address
Web Address
Name of contact person
Owner's Name
Owner's Title
Geographic Area Served
Local
Regional
National
International
Annual Sales $
Year Established
Number of Employees
Number of Minority Employees
Business Structure
Federal Tax Number
Other Certifications
Business Classification (Use NAICS codes)*
Codes(s)
Text Description
*The minority business directory is categorized by NAICS (North American Industry Classification System) codes. If you do not know your NAICS codes, call 888-75NAICS, visit www.census.gov/naics, or pick up the NAICS directory at your local library or bookstore and determine the codes right for your business.
Business Description (published in the minority business directory.)
DESCRIPTION WILL BE TRUNCATED AT 255 CHARACTERS.
Which NMSDC affiliate is your primary council?
When is your expiration with that council?
Your Rocky Mountain MSDC expiration will be concurrent with your primary council.
Policies and Procedures for Certification
Any arrangement between a minority business concern and other parties which involves apparent minority fronts, or other circumstances which would tend to circumvent the certification process by placing any substantial control of the minority business concern with non-minority individual(s) will be closely examined and will result in a denial or revocation of affiliate certification. In addition, reapplication for certification under such circumstances will be denied.

Submitting false information is a Class II felony punishable if the council chooses to press charges.

The undersigned herby swears under penalty of law that all statements made in the application are true.

The undersigned agrees to hold the Council harmless for any claim arising out of this application and agrees to indemnify the Council for any liability in connection with the certification of the applicant.
Business Name
Signature of Proprietor, all Partners, or President of corporation:
Signature
Signature
Signature
Date
Date
Date
Fee to file Reciprocal Certification Application: $150.00
To submit your application please click the submit button then proceed to the "Buy This" button. Thank you.