Please make sure to answer all the following questions as detailed and concise as possible, and complete the acknowledgement and signature. Incomplete applications will not be reviewed by the Supplier Diversity Council.

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* 1. General information:

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* 2. Referred by:
(Referido por)

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* 3. What is the date that the company was established?
(Cual es la fecha en que se estableció la empresa?)

Date

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* 4. Please check all that apply:

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* 5. Are you currently a member of any of the following organizations?

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* 6. Why would you like to become a diverse-certified business through FSMSDC or WBENC?
( ¿Por qué le gustaría convertirse en un negocio con certificación diversa a través de FSMSDC o WBENC?)

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* 7. Please provide a detailed description of the type of products or services that are provided by your company
 (Provea una descripción detallada del tipo de producto/servicio que suministra su empresa?)

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* 8. What is the geographic location coverage offered by your business?
 (¿Cuál es la  localización geográfica donde su empresa ofrece servicios?)

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* 9. What are the companies clients? (name, title, telephone number and email address)
(¿Cuáles son los clientes de la empresa? (nombre, título, número de teléfono y dirección de correo electrónico))

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* 10. What type of clients are you looking to do business with in the future? For example: small to medium sized business, large businesses, corporations, government, etc. (¿Con qué tipo de clientes desea hacer negocios en el futuro? Por ejemplo: pequeñas y medianas empresas, grandes empresas, corporaciones, gobierno, etc.)

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* 11. Please list your sales volume per year over the last 3 years. If no sales volume, please submit a sales forecast or pipeline of prospective sales/clients. (Information is kept confidential and only shared with HCCMO Supplier Diversity Committee) 
(¿Cuál es el volumen de ventas en los últimos 3 años ?  Si no hay volumen de ventas, por favor incluya su pronóstico de ventas o una lista de posibles ventas / clientes. ( La información se mantiene confidencial y sólo se comparte con el Comité Proveedores de Diversidad de la Cámara)

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* 12. If your company has been in business for less than 3 years, please include additional information about the business owner's related experience prior to opening the business. 
( Si su empresa ha estado en el negocio por menos de 3 años, incluya información adicional sobre la experiencia relacionada con el propietario del negocio antes de abrir el negocio. )

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* 13. Please provide the company's insurance coverage:
(Favor de proporcionar las cubiertas de seguro de la compañía)

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* 14. Please provide your comapny's business goals that you would like to accomplish after you receive certification. (For example: Piper's Cleaning Services would like to present their services to Wyndham Destinations and Orlando Health, in order to establish a business relationship and apply for future bids, etc.) 

(Por favor proporcione los objetivos comerciales de su empresa que le gustaría lograr después de recibir la certificación. (Por ejemplo: Piper's Cleaning Services desea presentar sus servicios a Wyndham Destinations y Orlando Health, para establecer una relación comercial y solicitar futuras ofertas, etc.)

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* 15. Please include any additional comments about your company in the comment box below:
(Por favor incluya comentarios adicionales sobre su  compañia en el cuadro de comentarios abajo: ) 

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* 16. Please upload any related documents (company's capability statement, resume, etc.)
(Por favor subir documentos relacionado de su applicacion. Por ejempo, su compañias declaración de capacidad, currículum, etc.) 

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