Nomination Form

  • Nominee ( Founder / Existing Owner )
  • HAITI
  • USA (if applicable)
  • Business Address

  • NamePositionPhone Number 
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  • If your enterprise spans several categories, choose the category that best describes your company. Final category placement is at the judges discretion.
  • Core capabilities, Products/Services, Customer Segments, Distribution Channels, Strategic Alliances, Business Founding Methods, Key Milestones
  • Financial Perfomance

    The following table must be completed as it is an important indicator of the company's success for the judging panel. Please note that all information provided will be treated confidentially and viewed only by the judges
  • 2016 Y/E2015 Y/E2014 Y/E2013 Y/E 
  • 2016 Y/E2015 Y/E2014 Y/E2013 Y/E 
  • 2016 Y/E2015 Y/E2014 Y/E2013 Y/E 
  • 2016 Y/E2015 Y/E2014 Y/E2013 Y/E 
  • NameMarket Share % 
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