Fillable NC SMALL BUSINESS ENTERPRISE PROGRAM APPLICATION (North Carolina)

Fill Online, Printable, Fillable, Blank NC SMALL BUSINESS ENTERPRISE PROGRAM APPLICATION (North Carolina) Form

Use Fill to complete blank online NORTH CAROLINA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

NC SMALL BUSINESS ENTERPRISE PROGRAM APPLICATION (North Carolina)

On average this form takes 15 minutes to complete

The NC SMALL BUSINESS ENTERPRISE PROGRAM APPLICATION (North Carolina) form is 3 pages long and contains:

  • 1 signature
  • 39 check-boxes
  • 38 other fields

Country of origin: US
File type: PDF

BROWSE NORTH CAROLINA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
N.C. Department of Administration
Office for Historically Underutilized Businesses
North Carolina Small Business Enterprise Program
1336 Mail Service Center, Raleigh, NC 27699-1336 | (919) 807-2330 | Fax (919) 807-2335
Website: www.doa.nc.gov/hub * Email Address: HUB.NCSBE@doa.nc.gov
Pamela B. Cashwell
Secretary
Tammie Hall
Director
NC SMALL BUSINESS ENTERPRISE PROGRAM APPLICATION
Thank you for your interest in becoming certified as a NC Small Business Enterprise (NCSBE) vendor with the
State of North Carolina. The NCSBE Program is a race and gender-neutral program designed to provide
contracting opportunities to NC small businesses with the State of North Carolina. The applicant must be a small
business as defined in Executive Order 143 and must meet the size standards that are measured by annual net
income of not more than $1,500,000, after cost of Goods Sold is deducted with 100 or less employees and based
in the state of North Carolina.
If your business is an actively certified HUB firm, a new application is not required. As a certified HUB firm,
applicant must complete, sign, and submit an Affirmation Letter. If NOT a certified HUB Firm, please complete the
following application and submit the required documentation to the NCSBE Program Office within 30 days of your
application.
The NC Small Business Enterprises Program requests documentation to determine your eligibility for certification
as a NC Small Business Enterprise. All non-HUB applicants are required to submit this application as part of the
required documentation.
To initiate the NCSBE Certification Process: (1) Register on eVP as an IPS vendor (2) Complete the NCSBE
Program Application (3) Gather and submit required documents (4) Complete the Registration Process by
submitting (via Mail, Fax or email) your completed package to the NC Small Business Enterprise Program.
Business Name
Contact Name
Title
Business Phone #
Cell Phone #
Email Address
Physical Address (In North Carolina – P.O. Box not accepted)
Mailing Address (only if different from physical address)
County
*Annual Net Income (after Cost of Goods sold deducted):
*Required Information
*Total Number of Employees:
*Required Information
NCSBE Application 02/17/21 Page 2 of 3
Business Identification
Business Legal Company Name
Unique Identifier for Business
(Select One) PLEASE DO NOT ENTER INFORMATION REGARDING
THE FOLLOWING AT THIS TIME.
❑ DUNS ________________
❑ OTHER ______________
Method of Acquisition
Started new business
Bought existing business
Merger or consolidation
Inherited business
Other
Business Profile
Business structure
❑ Corporation (including PLLC)
❑ Limited Liability Company
❑ Partnership (including LLP)
❑ Sole Proprietorship
❑ Joint Venture
Business Relationship with Other Businesses
Is your business co-located at any of its locations with any other business, organization, or entity? If yes, who?
Does your business, at any of its business locations, share a phone number, P.O. box, office space, yard, warehouse, facilities,
equipment or office staff with any other business, organization, or entity? If yes, who?
Do any of your immediate family members own or manage another business? If yes, explain.
At present, or at any time in the past, has your business:
▪ Been a subsidiary of another business? Y or N
▪ Consisted of a partnership in which one or more of the partners are other businesses? Y or N
▪ Owned a percentage of another business? Y or N
▪ Had any subsidiaries? Y or N
▪ Operated under a franchise agreement? Y or N
▪ Has any other business had an ownership percentage in your business? Y or N
Section 3. Ownership Information (Ownership percentages must total 100)
If there are more than two owners, attach a separate sheet.
Owner #1: Percentage Owned: _______%
Name
Title
Contact Phone #
Ethnicity:
Information is not required to qualify; for internal use only.
Gender
Male
Female
Unlisted:
_____________
Information is not required
to qualify; for internal use
only.
Disabled
Yes
No
Disadvantaged
Information is not
required to qualify; for
internal use only.
*Are you a U.S. Citizen or
permanent resident alien of the
U.S.?
Yes
No
*Required Information
Do you own any other businesses? If yes, please list.
Do you work for any company, organization or entity that has a relationship with applicant business? If yes, please list.
Owner #2 Percentage Owned: _______%
Name
Title
Contact Phone #
Ethnicity:
❑ Black
Hispanic
Asian American American
Indian
❑ Unlisted: _______________
Information is not required to qualify; for internal use only.
Gender
❑
Male
❑
Female
❑
Unlisted:
____________
Disabled
Yes
No
Disadvantaged
Information is not
required to qualify; for
internal use only.
Are you a U.S. Citizen or
permanent resident alien of the
U.S.?
Yes
No
*Required Information
Do you own any other businesses? If yes, please list.
Do you work for any company, organization or entity that has a relationship with applicant business? If yes, please list.
I understand that the NCSBE Office may access all publicly available information in reviewing my business’
application.
___________________________________ ____________________________________
Signature of Owner Date
___________________________________
NOTE:TO AVOID DELAY IN PROCESSING YOUR CERTIFICATION, PLEASE CHECK YOUR APPLICATION AND
SUPPORTING DOCUMENTS TO ENSURE ALL REQUIRED INFORMATION IS INCLUDED
Page 3 of 3
NCSBE Application 02/17/21
Information is not required
to qualify; for internal use
only.
Print Name of Owner
❑ Black
Hispanic
Asian American American
Indian
❑ Unlisted: _______________
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

NC SMALL BUSINESS ENTERPRISE PROGRAM APPLICATION (North Carolina)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 1 March 2022

Message

View Audit Log
Print With Audit Log
Duplicate Document