* Required Field

COMPANY DETAILS

* Business Name * Type of Organization Select Individual/Sole Proprietor Partnership Corporation Not-For-Profit LLC SCorp * Tax Identification Number (TIN) Social Security Number (SSN) (ex: 123-45-6789) Employer Identification Number (EIN) (ex: 12-3456789)     * Address 1   Address 2 * City * State Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D C West Virginia Wisconsin Wyoming Non US * Zip * Number of Employees Select Below 200 Above 200 * Annual Revenue (USD $) Select 0-$1000000 $1000000-$3000000 $3000000-$5000000 Above $5000000 * Year Business Was Established * Bonding Capacity ($ USD)(no commas, no spaces)   (Bonding capacity essentially is the maximum value of work that a surety company allows a contractor to have on hand at one time. For instance, if a contractor is bonded for a million dollars, that contractor can not have more than 1 million in uncompleted work and still be legally represented by the bond purchased from the surety company.)

CONTACT DETAILS

PRIMARY CONTACT PERSON

The Primary Contact person will receive all email notification regarding this application. * First Name * Last Name * Title * Phone with Area Code (no hyphens, no spaces)  Ext   Fax with Area Code (no hyphens, no spaces) * E-mail Address Contact Address same as Company Address * Address 1   Address 2 * City * State Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D C West Virginia Wisconsin Wyoming Non US * Zip

SECONDARY CONTACT PERSON

First Name   Last Name   Title   Phone with Area Code (no hyphens, no spaces) Ext   Fax with Area Code (no hyphens, no spaces)   E-mail Address

ADDITIONAL COMPANY DETAILS

*	Please provide a brief description and history of your company.

	Is your business related to another company as described below?
	Parent Affiliate Subsidiary(s) Division Franchise N/A
	If you have selected from the list above, please provide the company name.

	List any other pertinent information about your organization.

	Former company name and the year business was established (if applicable):

TYPE OF BUSINESS

REAL ESTATE OPPORTUNITIES

Would you also like to be notified of upcoming NYCEDC real estate opportunities? Yes, I am interested in being notified.

BUSINESS CERTIFICATION

	Please check any certifications your business currently holds. You will need to mail proof of certification as instructed after submitting this form.
	MBE (Minority Business Enterprise) WBE (Women Business Enterprise) LBE (Locally Based Enterprise) DBE (Disadvantage Business Enterprise)

Please check the appropriate group classifications for the above certifications, if applicable.   Female African American Asian American Hispanic American

If your business is not currently certified, would you like to receive information about the NYC Certification Programs?   YesNo

REFERRAL INFORMATION

* How were you referred to the Vendor's List?   American Planning Association (APA) online Marine Log online Planetizen online Real Estate Weekly online The Architect's Newspaper online Urban Land Institute (ULI) online Crain’s NY Newsletter Engineering News Record (ENR) Newsletter Journal of Commerce (JOC) Newsletter Planetizen Newsletter The Architect's Newspaper Newsletter RFP/RFQ/RFEI Notification Email RFP/RFQ/RFEI Notification Letter Vendors List Email Solicitation Vendors List Postcard Solicitation MWD Email Solicitation MWD Brochure MWD Trade Show/Conference Friend/Colleague Trade Show/Conference Web Other

Minority and Women-owned Business Enterprises are particularly encouraged to apply. Visit nyc.gov to certify with the City of New York as a Minority and Women-owned Business Enterprise or call 311 for more information.

All information submitted in this form will be used for internal purposes only.

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