Apply Online Section I: Small/Minority Contractor Contact Information Date* Are You The Business Owner?* YesNo Mr.Mrs.Ms. First Name* Last Name* Job Title* Company* Address 1* Address 2 City* State* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code* Phone Number* Fax Number Email Address* Website <hr /> Section II: Small/Minority Contractor Business Information Business Type* Sole ProprietorshipPartnershipCorporationLLC Union Contractor* YesNo Date Business Established* Contractor’s License Number* Class* EIN* Federal Tax ID Number* Number Of Employees* Primary North American Industrial Classification System Code (NAICS)* You can determine your NAICS code on the SBA Website <a href=http://www.sba.gov/size/indextableofsize.html>here.</a> Other NAICS Code(s), if applicable General Contractors: Annual Revenue* Less Than $33.5MMore Than $33.5MI'm Not A General Contractor Specialty Trades: Annual Revenue* Less Than $14MMore Than $14MI'm Not A Specialty Trade Certified Small Business Enterprise (SBE)* YesNo Certifying Agency, if yes Certified Minority-Owned Business Enterprise (MBE)* YesNo Certifying Agency, if yes Government Public Works Project Experience* YesNo Assigning Agency, if yes <hr /> Section III: Small/Minority Contractor Statistical Information Gender* MaleFemale Ethnicity* African AmericanAleutAmerican IndianAsian AmericanCaucasianEskimoHasidic JewHispanicPacific IslanderOther Household Income* < $35k$36k to $51k$52k to $64k> $65k Military Status* VeteranDisabled Veterann/a <hr /> What is 2+2?* Please answer the question to prevent spamming <hr />