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CLEAR Sub Agent Application

(*) Indicates Required Fields
Personal Information
* Last Name	* First Name	* Address
* City	* State Select State AK AL AR AZ CA CO CT DC DE DL FL GA HI ID IA IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NY NV OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY	* Zip
* Email Address	* Phone
Why are you interested in becoming a CLEAR sub agent?
* Do you currently own a business? Yes No
Tell Us About Your Company
Company Name	Business Address check here if same as above
City	State Select State AK AL AR AZ CA CO CT DC DE DL FL GA HI ID IA IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NY NV OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY	Zip
Website Address	Type of Business
Markets Served: (check all that apply) Commercial Government  Residential  Specify % of sales Specify % of sales Specify % of sales
Your Annual Revenue --Select One-- Up to $100,000 $100,000 to $250,000 $250,000 to $500,000 $5000 to $1.5 million Over $1.5 million
What year did you establish your company?	Type of Company --Select One-- Sole Proprietorship Corporation Limited Liability Corporation
My Company is certified: --Select All that Apply-- Minority-Owned Business (MBE) Small Disadvantaged Business (SDB) 8(a) Firm Historically Underutilized Business Zone (HUBZone) Woman-Owned Small Business (WOSB) Veteran-Owned Small Business (VOSB) Service-Disabled Veteran-Owned Small Business (SDVOSB)
Describe your company’s product and/or services.
Please upload your corporate brochure (optional) (size limit <100KB) *Please only upload .doc, .docx or .pdf files.