Business Certification Affidavit
Business Certification Affidavit
Business Certification Affidavit
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Certified Women-Owned <strong>Business</strong>Information RequestPlease provide the following information. Your WBE <strong>Certification</strong> isvalid for a five-year period. To continue your certification thisinformation is to be updated annually for your file.Company Name _____________________________________________<strong>Business</strong> Address ________________________________________________________________________________________________________________Mailing Address (if different from above) ____________________________________________________________________________________________________<strong>Business</strong> Telephone Number ________________________________________<strong>Business</strong> Fax Number _____________________________________________Mobile number________________________E-mail______________________Number of Employees:Full-Time ___________ Part-Time ____________Has the female ownership status of your company changed: ________________If yes, please explain ______________________________________________________________________________________________________________Provide documents showing the change.Current Legal Structure: ___________________________________________