made in alaska - Alaska Department of Community and Economic ...

Print or type all requested information.
If you have questions, call (907) 272-5634 or email: madeinalaska@anchoragemarkets.com. Please complete and mail this
application along with a check or money order made payable to “State of Alaska”
Mail or Deliver to: MADE IN ALASKA
741 East 13th Avenue
Anchorage, Alaska 99501-4621
Business Name: ____________________________________________________________________________________
First Name (Owner/Contact): _______________________ MI: _____ Last Name: _______________________________
Parent Name: ______________________________________________________________________________________
Mailing Address: ____________________________________________________________________________________
City: ____________________ State: ____ ZIP Code: ____________ Business License No. _______________________
Physical Address: _________________________________________________________________ Same as Above �
City: _____________________ State: ____ ZIP Code: ____________ Previous MIA Permit #. _____________________
Phone (Business): __________________ Fax (Business): _________________ Toll Free Phone: ___________________
Phone (Home): ____________________ Fax (Home): ___________________ Selling Wholesale? Yes � No �
Email Address: _____________________________________________________________________________________
Website Address: ___________________________________________________________________________________
(1)
MADE IN ALASKA
MIA Initial Certifi cation Application - Page One
Description of Handicraft type or Product Line. Use additional sheets if necessary.
(Note: There is a $25.00 annual fee for each separate product line and a
$75.00 maximum fee per person or company with more than three product lines.)
Web Site Category #1 _______________________ Web Site Category #2 ________________________
(2)
Web Site Category #1 ________________________ Web Site Category #2 ________________________
(3)
Web Site Category #1 ________________________ Web Site Category #2 ________________________
Note: Before mailing this application, please complete the information
requested on the reverse side of this page.
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