Hot Tip:  Save the narrative

portion (e.g. Business Description, Success, etc) of your application in a Word document as a backup.  Then cut and paste from your Word document into the application  


Top 100 Minority Business Enterprise Award
Application Form

Deadline for Applications:

Wednesday August 12, 2009

(Early Bird Special:  Apply by July 31st and become eligible to win 2 free airline tickets anywhere Southwest Airlines flies!)

Applicant 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 (state) :  
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)

(PC crtl+click)
(Mac command+click)

  
   
Business Description:

Using the following format, please describe your business in 100 words or less.  The descriptions of the TOP 100 winners 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 Success and 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 in the judging process and will be published in the Top 100 MBE Magazine
  
   
Professional Affiliations, Achievements and Awards:
(This information is used by the judges)

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

Include current or previous service rendered to your community.
  
 
     
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.  Your signed client letter can be emailed to applicant@top100mbe.com  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 optional information will not be published. Your privacy will be protected. The data (without your name) is used in our research about minority and women entrepreneurs. In some cases the data is used to present special recognition and reward.
  
number of employees excluding yourself:  
2005-2008 average annual revenue:  
   
Affidavit:
I certify that all information contained in this application is accurate and true.  I also certify that I am a woman and/or minority business owner and the business referenced is my full-time venture..
 
 
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 ree tha Rob  bin sun
  
your name:  
     

**Please email your photo as an JPEG file attachment to applicant@top100mbe.com.  Please label your email or photo clearly with your name and business name.

Applications must be received no later than Wednesday, August 12th . All incomplete applications will be removed from the final judging.  Winner will be announced in September.

Questions? E-mail applicant@top100mbe.com or call 1-877-572-5963