Print and return this form to: Hispanic Network Magazine,
Attn: Amanda Roberts
6845 Indiana Ave Ste 200, Riverside, CA. 92506, (800) 433-WORK,
Fax (909) 924-1139 |
| By submitting my Vendor Application I hearby
authorize Hispanic Network Magazine and its affiliate companies to release
the information to prospective companies. I further attest that the information
provided is true and correct to the best of my knowledge. The information
Provided will be used to assist my company in building a partnership with
Corporate America. |
| Company Name: |
| Company Address |
| City/State/Zip: |
| Telephone/Fax/Toll Free: |
| E-mail Address: |
What type of certification do you have:
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| Years in Operation: |
| Product/Service Offered: |
Please Circle One:
Minority Owned
Women Owned
Disabled Veteran Owned |
Small Business Owner
Disabled Owned |
|
| Type of Business: |
| List the names and addresses of three firms you have provided products/services
during the past (3) years: |
| Name |
Address |
Contact Person |
Phone Number |
|
|
|
|
In 25 words or less, please summarize the supplies or services your
firm provides:
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