Business Directory Application | Chickasaw Business Network

*Is this company 51% or more owned by a Chickasaw citizen?

Yes

No

*Company Name:

Parent Company:

Physical Address

*Address Line 1:

Address Line 2:

*City:

*State:

*ZIP Code:

Physical address is home office

*Phone:

Fax:

Website:

*Email:

*Key Contact's Name:

*Key Contact's Title:

Employer's Federal Tax ID#:

SSN (For Indv Only):

*Primary Classification:

*Geographical Market:

*Type of Legal Business Structure:

Please check any certifications that the company holds.

8(a) Certification

Minority (MBE)

Hubzone

SBD Certification

Women Owned (WBE)

Disabled Veteran (DBVE)

National Minority Supplier Development Council

Business Description

Please give a concise description of the company products, services, or type of construction. If the company offers more than one product or service, list primary products or services first. *Description (max 300 characters):

Chickasaw Business Directory - Business Directory Application