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Certified BOB's
100% Black Owned Business
Registration
This form can be used for all Certified BOB's.
(BOB) 100% Black Owned, (MOB) 100% Afro-Mulatto Owned, (BOW) Blended - 51% Black Owned and (SOB 100%) Solidarity Owned.
Firm's Legal Name
Doing Business As (If different Legal Name)
Applicants Full Name (First & Last)
Federal Employer ID Number (xx-xxxxxxx)
Business Phone Number
Business Email
Business Address
This address is a? (Store, Office, Home)
Website
Mailing Address, if different. (Street Name, City, State & Zip, Unit)
Business Premises: *
Home-Based
Leased
Owned
Primary Owners Full Name (First and Last)
Phone Number
Secondary Owners Full Name (First and Last)
Title
Email
Title
Phone Number
Email
What kind of business is being registered?
*
Certified BOB (100% Black Owned)
Certified BOW (51% Black Owned)
Certified MOB (100% Afro-Mulatto Owned)
Certified SOB (100% Solidarity Owned, Any Race)
Type of Legal Business Structure
*
Corporation
Limited Liability Corporation or Company
Limited Liability Partnership
General Partnership
Sole Proprietorship
Date the business was started, acquired, purchased, or secured:
What was the business acquisition type?
*
Started Business
Purchased an Existing Business
Merger or Consolidation
Secured a Franchise
Please provide proof of purchase.
Upload File
Upload supported file (Max 15MB)
Please list ALL owners, proprietors, partners, officers, members, directors, stockholders, and managers. The names listed should include Minority Group Members and Non-Minority Group Members. {{List in this order 1. Full Name , }}
List the facility locations where assets are located:
Managing Employees Please list all responsible Officers, Members or key employees that are responsible for Managing Employees (e.g., day-to-day management): {{List in this order 1. Full Name - Title , }}
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