The intent of this survey is to collect contact information on minority-owned businesses and contractors in the Gulf Coast area, especially those operating and wanting to do business in Escambia County, Florida. 

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* 1. CONTACT INFORMATION:
Information provided in these cells will appear in business listing.

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* 2. PERSON COMPLETING THIS FORM: (If different than above)
This information is for contact and confirmation purposes only. It will not appear in the listing.  If same as above, enter SAME in cell #1

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* 3. NATURE OF BUSINESS SERVICES/PRODUCTS:
Select up to five (5). Feel free to specify speciality services/products in the OTHER option.

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* 4. SELECT ALL CATEGORIES THAT ACCURATELY DESCRIBE SAID BUSINESS:

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* 5. LICENSES/CERTIFICATIONS RELEVANT TO BUSINESS SERVICES AND PRODUCTS:
Provide full name of license/certification and issuing entity. If not applicable, enter N/A in Cell #1. 

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* 6. AWARDS/RECOGNITION FOR BUSINESS SERVICES AND PRODUCTS:
Provide full name of awards/recognition and issuing entity. If not applicable, enter N/A in Cell #1. 

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* 7. SERVICE AREA:
Select counties where this business can and will provide services.

By submitting this form you are requesting to have your business and its contact information added to the Escambia County Minority Owned Businesses & Contractors List, a project of Gulf Coast Minority Chamber of Commerce (GCMCC), Escambia County, Florida, the City of Pensacola Office Supplier of Diversity and Bantucola. Submission of  this form means you attest all information provided is up to date and accurate, the business is 51% minority and/or women owned and operated and grant the curator permission to publish all information provided. 

Thank you for your submission.
Please direct any questions, comments or concerns to (850) 438-3993 or info@gcmcc.info.

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