Equitable Contractor Connect Program

Name:*

First Last

Business Name:*

Business Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address (if different from physical address):

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone:*

Mobile Phone:

Email:*

Company Website Address:

Other Social Media Used (If Applicable):

Year Business was Established:*

How Long Have You Owned this Business?*

NAICS Code and Description:

Company Description:*

Primary Products/Services:*

Geographic Markets:*

Revenues (Last 3 Years):*

Number of Employees (Including CEO):*

Please outline your motivation to participate in Equitable Contractors Connect Program:*

Names of Senior Leadership, title, and length of employment with company (including CEO):*

Percent of business with government customers:*

Percent of business with corporation customers:*

Percent of business with retail:*

Percent of business with other (describe):*

Is you company 51% minority owned and operated?*

Is you company 51% women owned and operated?*

Indicate Minority Certification(s) held:

Are you 8a certified?*

Growth Plans for your company (indicate projected revenue) Yr1, Yr2, Yr 3:*

Describe how you plan to achieve growth rates:*

Indicate business improvement actions taken in last 24 months:*

What are your expectations of the Equitable Contractors Connect Program?*