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Holiday Financial Services Supplier Portal Form
Company Information
Type of service:
Legal Company Name:
Street Address:
City:
State:
Zip Code:
Phone:
Email Address:
Website:
Current customer?:
Yes
No
Are you a diverse-owned business enterprise?:
Yes
No
Please select yes if your company is at least 51% owned and operated by citizens who are ethnic minorities, women, veterans, LGBT, or disabled.
Are you a small business owned enterprise?:
Yes
No
Please select yes if your company qualifies as a Small Business under the
SBA’s (Small Business Administration) Size Standards
.
Target radius willing to travel/serve (in miles):
0-25 miles
26-50 miles
51-100 miles
101+ miles
Expected/average response time when contacted:
Company Contact
Primary Contact Name:
Primary Contact Title:
Primary Contact Phone:
Primary Contact Email Address:
References
Contact Person:
Business Name:
Phone:
Email Address: