Minority-owned Business Certification Form

Select Certifications

• MBE (Minority-owned Business Enterprise)
• WBE (Women-owned Business Enterprise)
• VOSB (Veteran-owned Small Business)
• SDVOB (Service-disabled Veteran-owned Business)

Name of Corporation, LLC, Partnership or Instrument:

Select Entity TypeProfit CorporationProfit CorporationNon Profit CorporationLimited Liability CompanyProfessional CorporationProfessional Limited Liability CompanyLimited PartnershipTrustLimited Liability Limited PartnershipFamily Limited PartnershipGeneral PartnershipLimited Liability PartnershipSole Proprietorship/Fictitious NameLast Will and Testament

Year of Entity Formation:

State of Incorporation or FormationAlabamaAlabamaArizonaAlaskaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIndianaIowaIllinoisKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNevadaNebraskaNew YorkNew JerseyNew HampshireNew MexicoNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming

Your Position in Entity (Check all that apply)

• Chairman
• President
• Operating Manager
• Shareholder
• Member
• Vice President
• Secretary
• Trustee
• Beneficiary
• Treasurer

Was Entity formed by Spiegel & Utrera, P.A.?

• Yes
• No

Your Name: *

Your Telephone Number: *

Your Email Address: *

Submit Your Details To Get Started