2014-2015
US Pan Asian American Chamber of Commerce
Southwest
Application Form
(Please print)
Company Information
Company Name
Industry
ASIAN AMERICAN
BUSINESSES
TOP
Headquarters Address
City
State
Phone
Zip code
Fax
Website
Is Your Company: Public □ Private □
What is the Top 10 Asian American Business Award?
The Top 10 Asian American Business Award recognizes the 10 fastest growing Asian
American-owned companies, based on percentage revenue growth over three
years (2012 to 2014 for FYE between January and June).
Top 10 winners will be publicly recognized during our February 7, 2015 Lunar New Year
event at Kirin Court Restaurant in Richardson.
What companies can apply or be nominated for the Top 10?
Are You A USPAACC-SW Member? Yes □ No □
CEO/Owner Information
Mr./Mrs./Ms. Name
Title
Phone
CFO Information
Mr./Mrs./Ms. Name

Owned (at least 51%) by one or more Asian Americans
Title

Have at least $500,000 - $1,000,000 in revenue during 2012 – 2014
Phone

In business for a minimum of three years

Headquartered in the U.S. Subsidiaries or divisions are ineligible (unless they have
some public ownership and are separately traded)

Contribute to community
Fax
Email
Fax
Email
Contact Person Information (if different from CEO)
Mr./Mrs./Ms. Name
Title
Phone
Fax
How to apply?
Email
Companies may be nominated or may apply directly by sending to USPAACC-SW the
completed Application Form with supporting documents, including the company’s
last three FYE financial statements prepared by a third party.
“I certify that the financial information provided is accurate”
APPLICATION DEADLINE: Thursday, January 15, 2015
Mail, Fax, or Email the application to USPAACC-SW, 202 E. Border St. Suite144, Arlington,
TX 76010; (682) 367-1393; (fax) (817) 469-9485; janine@uspaacc-sw.org
CEO Name
Signature
Date
Important: Financial statements prepared by a third party for FYI 2012, 2013, 2014 (January
through June) must be submitted with this application.
More Info.
USPAACC Southwest • 202 E. Border Street , Suite 144, Arlington, TX 76010
(682) 367-1393 (Fax) • (817) 469-9485 • www.uspaacc-sw.org
Janine Wong• (682) 367-1393 • janine@uspaacc-sw.org