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MBAC Certification

"*" indicates required fields

Name*

First Last

Phone*

Email*

Company Name*

Detailed description of your business:*

What year did you register your LLC/S-Corp/C-Corp?*

What year did you begin operating your business?*

Do you own 100% of the business? Y/N*

If no, who is the majority owner? Break down percentages of ownership & titles. (For example, John Smith; 21% owner, Administrator) [Who are your partner(s)? First and last name. Percent of ownership & titles?]*

Which Ohio county do they reside in?*

Address*

Street Address Address Line 2 - Mark N/A if not applicable City State / Province / Region ZIP / Postal Code Country

County*

List race of the majority owner of the business:*

Native American/Alaska Native

Black/African American

Asian, Native Hawaiian or other Pacific Islander

Non-minority

Gender of the majority owner: M/F*

Reason for Certification:*

Loans

Contract opportunities

Both

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MBAC Certification

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