WOSB/WBE (Woman Owned Small Business) Contact Name* Contact Phone*Contact Email Address* Company Name* Company Type*C CorpLLCS CorpLTDSole ProprietorshipDUNs* EIN/TIN* Qualifying NAICS Code* Certification Type WBE WOSB Both 1. WBE Applicants: Is your company at least 51% owned and controlled by one or more women who are U.S. Citizens or Permanent Legal Residents? Yes No 2. WBE Applicants: Is your business formation and principal place of business located in the U.S. or its territories? Yes No 3. WBE Applicants: Is the company's management and daily operation controlled by a woman with industry experience? Yes No 4. WBE Applicants: Has you company been denied WBENC Certification within the last 6 months? NOTE: If you are unsure, please consult the female owner and/or the Regional Partner Organization (RPO) to confirm. Yes No 5. WBE Applicants: Were your firm's Annual Gross Receipts for the last year $500 Million or more? Yes No 6. WBE Applicants: Do you agree to pay the nonrefundable application processing fee? Yes No 7. WOSB Applicants: Is the majority woman owner(s) a U.S. citizen? (Please select N/A if you do not want to be considered for WOSB.) Yes No Not Applicable 8. WOSB Applicants: Does the Woman holding the highest defined position work in the business at least 30 hours per week during normal hours of operation? (Please select N/A if you do not want to be considered for WOSB.) Yes No Not Applicable 9. Do women make up a majority of the Board of Directors OR have a majority of the Board votes through weighted voting? OR Do the women who up 51% of the voting power sit on the Board AND have enough voting power to overcome any supermajority requirement? (Please select N/A if you do not want to be considered for WOSB.) Yes No Not Applicable 10. Do you work as a W-2 employee with any other organization(s)? Yes No If yes, please explain. Be sure to include the average number of hours worked per week* As an officer, director, owner, legal representative or authorized representative of the organization stated throughout this document, I attest that all information provided is true and correct to the best of my knowledge. Signature* Title* Date* MM slash DD slash YYYY Organization Name*
Call the USBRI SAM REGISTRATION HELP DESK: 1-888-646-9998
Call the USBRI SAM REGISTRATION HELP DESK: 1-888-646-9998