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U.S. Department of Commerce MBDA Export Initiative Operated by the CalAsian Chamber Intake Form

Salutation

Minority Group

American Indian

Alaska Native

Asian

Asian Indian

Asian Pacific American

African American

Native Hawaiian or Other Pacific Islander

Hasidic Jew

Hispanic American

Non-Minority

About Your Business

Business Start Date

Please List Your States of Operation

Business Structure

Limited Liability Company

Limited Liability Partnership

C Corporation

Sub Chapter S Corporation

Partnership

Sole Proprietorship

Other For Profit

Other Non-Profit

Business Revenue

Business Sector/s

Clean Technology

Construction

Food and Beverage

E-Commerce

Import/Export

Infrastructure

Technology/IT

Manufacturing

Professional Services

Retail/Wholesale

Other

Certifications

SBA 8(a)

CUCP DBE

DGS DVBE

NMSDC MBE

SBA WOSB

SBA HUBZONE

CPUC MBE

CPUC MWBE

DGS SB

SFHRC LBE

WBENC WBE

Other

Licenses and Other Registrations

Union

Yes

No

Expiration Date (MM/DD/YY)

Business Description

I herby certify that the above information is true and complete to the best of my knowledge:

E-Signature

Date Signed

Thanks for submitting! An MBDA Representative will contact

you in 2-3 business days!

2020 CIRCLE OF EXCELLENCE SPONSORS

founding

CalAsian Chamber of Commerce

2331 Alhambra Blvd, Suite 100

Sacramento, CA 95817

916.446.7883

Mailing address:

P.O. Box 5387

Sacramento, CA 95817