Vendor Registration

Company’s Legal Name *

Business Type

What kind of products/services does your company offer? *

NAICS Code

MBE (Minority Business Enterprise)

Yes

No

Company Website (if applicable)

Age of Firm (years)

Company Address

Address Line 1

Address Line 2

City

State

Zip Code

Name of Representative

First

Last Name *

Last

Email *

Phone

Registered as a DBE (Disadvantaged Business Enterprise) in Massachusetts?

No

Black Americans – Persons having origins in any of the Black racial groups of Africa

Hispanic American – Persons of Mexican, Portuguese, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race

Native Americans – Persons who are American Indians, Eskimos, Aleuts, or Native Hawaiians

Asian-Pacific Americans – Persons whose origins are from Japan, China, Taiwan, Korea, Vietnam, Laos, Cambodia, the Philippines, Samoa, Guam, the U.S. Trust Territories of the Pacific, and the Northern Marianas

Asian-Indian Americans – Persons whose origins are from India, Pakistan, and Bangladesh

Women – Regardless of race, ethnicity, or origin

Other – Individuals found to be disadvantaged by the Small Business Administration Pursuant to Section 8(a) of the Small Business Act