Top 100 Minority Business Enterprise Award
Nomination Form

Deadline for Nominations:

July 31, 2008

Nominee Information
last name:
first name:  
title:  
business name:  
address:  
city:  
state:  
zip:  
county:  
phone:  
fax:  
email:  
website:  
     
For Administrative Use Only:
home address:  
city:  
state:  
zip:  
phone:  
Check here if you prefer correspondence to be mailed to your home.
Otherwise, mail will be sent to your office.
  
 
year established:  
where:  
industry sector:  
If you selected other please explain:  
     
Headquarters Location: (if different from business address):
address:  
city:  
state:  
zip:  
     

business classification:
select all that apply
(ctrl + click to select mutiple items)

  
   
business description:

Using the following format, please describe your business in 100 words or less.  This segment will be published in the Top 100 MBE Magazine.   Please start your description with the following sentence.  

The (name of your company) is/provides……       Click here for a description example.
  
 
   
business sucecess adn contributions:

(Please tell your story in 200 words or less, including  (a) why you became an entrepreneur, and (b) your proudest accomplishment as a business owner.  This information is used by the judges and will be published in the Top 100 MBE Magazine
  
 
   
professional affiliations, achievements and awards:

(List all current or previous business achievements, awards and affiliations with professional organizations.)   This information is used by the judges.
  
 
     
community service:

(Include current or previous service rendered to your community.)  This information is used by the judges.
  
 
     
Customer Relationships:   (This information is used by the judges.)

We require a reference letter from one of your clients.  Please have your client submit a letter before the application deadline.  It can be emailed  or mailed under separate cover. 
 
client's name:  
client's title:  
client's business name:  
client's address:  
city:  
state:  
zip:  
client's phone:  
client's email:  
     
Optional Information
  
The following information will not be published but will help the judges ascertain the scope of your business. It may also be used for special recognition or awards.
  
numberof employees excluding yourself:  
2005-2007 average annual revenue:  
   
Optional:  You may provide one client reference letter. If not included with this application, letter must be received by application deadline to be considered.
  
 
     
Affidavit:
I certify that all information contained in this application is complete and correct.
 
 
date:  
     

Required:

**To ensure the correct pronunciation of your name, please provide the phonetic spelling of your name for the announcer.

For example:  Dorethea  Robinson  pronounced Door re tha Rob  bin son
  
your name:  
     

**Please email your photo as an JPEG file attachment.  Please label your photo clearly with your name and business name.

Applications must be received no later than July 31, 2008. All incomplete applications will be removed from the final judging.  

Questions? E-mail applicant08@top100mbe.com or call 1-410.489.7098