CMSDC Subscription Services Application

Subscription Services Application

Please answer all questions as completely as possible. If a particular question does not apply to your business operation, write “N/A” (not applicable) in the space provided.
Date of Application

MonthDayYear
Date
NMSDC affiliate council where company obtained original certification
Certification Date

MonthDayYear
Date
Company
DBA (if applicable)
Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Telephone
Please enter a valid phone number.Format: (000) 000-0000.
Fax
FEIN or Social Security Number
Website Address
E-mail Address
example@example.com
Key Contact's Name (preferably owner/principal)
Key Contact's Title
In the space below, please give a concise description of your company's product(s) or service(s) as documented by your home council. The description will be placed in our database and online directory.
NAICS Code(s)

Owner(s) Information

*Citizenship Status: 1 = By Birth or 2 = Naturalized Citizen | **Ownership must total 100%
Type of Business (check primary function)

Other
Type of Legal Business Structure
*NMSDC's definition of sole proprietorship is a company owned/operated 100% by one (1) individual or married couple. Split ownership does not constitute sole proprietorship.
Date Business Was Established

MonthDayYear
Date
Does your firm hold 8(a) certification?
Please provide the most current gross receipts of your firm.
Geographic Market (fill in where applicable). List locations that the firm serves or is capable of serving.
Provide Three Current Customer References
- Company #1
- Buyer
  
  First NameLast Name
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Company #2
- Buyer
  
  First NameLast Name
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Company #3
- Buyer
  
  First NameLast Name
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code

< $1 million

$300.00

$1 to $10 million

$550.00

$10 to $50 million

$675.00

> $50 million

$875.00

Enter coupon

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country