Company Address and Contact Information

Company Name
Street (Cannot accept P.O. Box address)
City
State
ZipCode
Contact Name
Contact Title
Contact Telephone Number
Contact Fax Number
Contact Email Address
Company Telephone Number
Company Fax Number
Company Website Address

Company Information

Business Ownership Classification (Check all that apply)

Small Disadvantaged Business or 8(a)*

Ethnicity:

HUBZone Small Business*

Women-owned Small Business

Service-Disabled Veteran Owned Small Business

Veteran Owned Small Business

* Must be certified by the Small Business Administration and registered as such on the Small Business Administration Pro-Net database.

Primary North American Industrial Classification System Code(s) (NAICS)
Other NAICS codes
Dun & Bradstreet Number

Service Capability(Check all that apply)

Local(Indiana) Regional National International

Business Type:

If Other Service Type selected, please specify:
If Other Business Type selected, please specify :

Capabilities:

Special Equipment / Materails:

Describe Your Quality Program/System (include ISO Compliant/Certification):

Three Major Customer References:

Comments: