PIEDMONT BUSINESS ETHICS AWARD
Nomination Form

NOMINEE INFORMATION:

Company
Business Address


Company Contact
Please be sure this person is in charge of completing the company’s application.
Telephone
Fax
Email

Category: A: Under 50 employees B: 50-150 employees C: 151-500 employees D: Over 500 employees
Brief Description of Business: Note: Non-profit organizations and financial service companies are not eligible to participate. A financial service company is one that derives 25% or more of its revenues from providing financial services or from the sale of financial products (e.g. CPA, brokerage and insurance firms, banks, etc.)
Brief Explanation for Nomination:
Your affiliation with the nominee:
Society Members: Chapter Affiliation:
Nominator Information:
	Self Nominated
Name:
Title:
Address:


Telephone:
Fax:
Email: