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SMALL BUSINESS REGISTRY

Company Name:   Years in Business:   SIC Code (if known):
Company Address (New Orleans) :   City: State: Zip:
Company Telephone No.:      
Type of Business:    Legal Entity: (INC., LLC, Sole Proprietorship):
State of Registry:     No. of Employees:   Largest Job/Contract: $  Average Job/Contract: $
Bonding Capacity (if applicable):      Insurance Type:
Principal Owner(s):  1.Name    2. Name   3 .Name
New Orleans Address (Home):   City/Area:   Zip:
Council District (A,B,C,D,E)  
Current Address:   City: State:   Zip:
 Current Telephone:   Current E-mail:   Current Fax:

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Revised: 11/10/05.