Escambia County Minority-Owned Businesses & Contractors Survey

The intent of this survey is to collect contact information on minority-owned businesses and contractors within Escambia County Florida. Thank you for your submission. Please direct any questions, comments or concerns to (850) 438.3993 or info@gcmcc.info.

1.CONTACT INFORMATION:
Information provided in these cells will appear in the business listing. (Required.)

Business Name:

Owner, First & Last Name:

TItle:

Business Primary Phone Number:

Business Primary Email Address:

Business Website/Facebook Page:

Full Business Address:
(include street number, street, suite (if applicable), city, zip code)

2.PERSON COMPLETING THIS FORM:
This information is for confirmation purposes only and will not appear in the listing. (Required.)

First & Last Name:

TItle:

Are you an authorized employee of this business?

Phone Number:

Email Address:

5.LICENSES/CERTIFICATIONS RELEVANT TO BUSINESS SERVICES & PRODUCTS:
Provide full name of license/certification and issuing entity. If not applicable enter N/A in Cell #1.(Required.)

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2.

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5.

6.AWARDS/RECOGNITION FOR BUSINESS SERVICES & PRODUCTS:
Provide full name of award/recognition and issuing entity. If not applicable enter N/A in Cell #1.(Required.)

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2.

3.

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7.SERVICE AREA: Select counties where this business can and will provide services.(Required.)

Other (please specify)

By submitting this form you requesting to have your business and its contact information added to the Escambia County Minority Owned Businesses & Contractors List a project of Gulf Coast Minority Chamber of Commerce, Escambia County, Florida, the City of Pensacola Office Supplier of Diversity and Bantucola. In addition, submission of this form means you attest all information provided is up to date and accurate, your business is 51% minority and/or women owned and operated and grant the curator permission to publish all information provided.