Additional Status

    Are you a veteran?

    Company Information

    Please fill this section out to the best of your ability. If you do not own a company, please fill out your home address under company address.

    Company Name

    Street Address


    State / Province / Region

    Postal / Zip Code




    Annual Sales Volume

    How many employees does your firm currently have?

    How many 1099 Contractors do you have?

    Are you in a Union? If answer is YES please submit which Union you belong to. If this does not apply to you submit "NO"

    What is your family's health insurance coverage?

    What kind of health insurance do you have?

    Briefly describe the nature of your business.

    Which areas do you need assistance?

    Which of the following apply to you? (Choose as many as you like)

    If you selected Other, please specify:

    List your current certifications (if any)

    What are your expectations of joining USMCA? What are your primary goals?

    By checkmarking the below statement, I agree that all the information in this application is true to the best of my knowledge. If selected to participate and join the USMCA, I authorize the ongoing sharing of information with USMCA, including this report and any future progress, attendance, and/or termination.