GBIC International Resource Directory Registration Form

GBIC International Resource Directory Registration Form

To register your business with GBIC, we are required to obtain certain information from you. Please fill out the form below as accurately as possible. If you are unsure of an answer or not able to provide an answer, please skip the entry and continue.

Please do not use the following character in filling our online form: > < : % + &.. OTHERWISE YOUR FORM CANNOT BE PROCESSED BY OUR SYSTEM.

* Indicates required fields.

Date*

Federal ID #*

Dun & Bradstreet Number

1. Company Information

Company's Legal Name*

D/B/A Company Name

Owners Name

if sole proprietorship

Company Contact Name*

Title of Contact

Phone*

Fax

Address 1*

Address 2

City*

State Zip*

Email Address*

Website Address URL

2. Business Classification Information

Gender*

Class*

Other

Category*

Business Type*

Other

Do you have a certificate?*

Certifying Agencies Name*

Certification Type

Certificate Number

Expiration Date(MM/YYYY)

3. Financial Information
Gross Annual Sales Revenue for past three (3) years. (example: 10M)

2004*

2003*

2002*

Legal Structure*

Number of employees (full time)*

Geographic Area Coverage*

Years In Business*

4. Product and Service Offerings

Product/Service Offered(primary)*

NAICS Code

SIC Codes

Product/Service Offered(secondary)*

NAICS Code

SIC Codes

Product/Service Offering(Tertiary)
255 character limit. Do not use 'enter key' or colons.

NAICS Code(Tertiary)
www.naics.com/search.htm

SIC Codes(Tertiary)
www.siccode.com

Other NAICS Codes or SIC Codes

5. Three Business References

Business Reference #1*

Contact Name*

Phone*

Business Reference #2*

Contact Name*

Phone*

Business Reference #3*

Contact Name*

Phone*

Provide brief project description (from references) relevant to doing business with GBIC
255 character limit. Do not use 'enter key' or colons.

6. Additional Information and Comments

Who referred you to GBIC?

Source Name

Additional Comments (500 character limit, sentence case format. Do not use 'enter key' or colons.)

Should you need further assistance, please contact us at (469) 855-9167.