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Minority Business Directory Intake
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Email
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Name of Business?
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Address of Business?
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City/ State/ Zip
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Contact Phone:
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Contact Email:
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Website:
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Certified Business (Type) MBE,WBE,VBE,EDGE
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What County are you located in?
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Who is the point of contact?
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What service/ good does your company provide?
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Please read and sign our Pledge to Supply Chain Diversity.
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