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Government contracts (UT-CIS ptac)

Getting Started - The New Client Questionnaire

New Client Questionnaire:

In order to secure PTAC services, the registering company must be located in Tennessee. Information with a red * MUST be provided in order to complete and submit this questionnaire. However, all the information on this questionnaire, and more, is required to do business with the Federal Government. So, please take the time and provide all of the information possible. Thank you, and if you have questions, at any point, please give Debbie a call at (615) 532-4916.

 Contact Information
* First :     M.I. :
* Last :    
*Title :
* Email Address :

 Company Information
* Company Name :
* Mailing Address :
* Physical Address :
* City :
* State :
* Zip Code :
* County :
* Phone : Fax :
Web Address
* Tax Payer ID# :
(No Dashes)
* DUNS # :
(No Dashes)
Organization Type :
Corporation Partnership
Sub S Corporation Limited Liability
Sole Proprietor Non-Profit
State Incorporated :
Date Established : / /
Annual Sales : average of past three years

Principals
Name :     Title :
Name :     Title :
Name :     Title :
US Citizen Owned :
yes no (Requires 51% or more of active US Citizen ownership to be US owned.)
Woman Owned :
yes no (Requires 51% or more of active woman/women ownership to be Woman owned.)
Disadvantaged Business Enterprise (DBE) Certified: (Governor’s Office of Diversity Enterprise)
Certified :
yes no
Small Disadvantaged Business (SDB)/8a
Certified :
yes no
Veteran Business Development
Veteran :
yes no
Service Disabled :
yes no
Vietnam Veteran :
yes no
Hubzone Certified :
yes no

Other Business Data
Number of Full-Time Employees :
Number of Part-Time Employees :
Facility Square Footage :
Number of Inventory Items :
Number of new products introduced this past year :
Number of new products introduced past 3 years :
Briefly describe the products or services you wish to sell to the government:
List all appropriate Standard Industrial Classification (SIC) Codes:
List all appropriate North American Industrial Classification System (NAICS) Codes:
List all appropriate Federal Supply Codes (FSC)/Product Service Codes (PSC):

What are FSCs/PSCs?

Federal Supply Codes (FSC) and Product Service Codes (PSC) are numerical codes designed by the government to create descriptions for products and services. They are not specific to small businesses and do not describe business size.)
Central Contractors Registration (CCR)
Is your company registered on CCR?
yes no
Cage Code :
Additional Technical Assistance Needed?
Business Transformation
Energy
Environmental
Growing Your Business
Human Resources/Personnel
ISO 		Information Technology
Lean
Quality
SBIR/STTR
Safety
Training Videos
Complete PTAP Registration Form
By including your initials, checking the box and clicking submit below, you indicate your agreement to the following: In consideration of inclusion in the Procurement Technical Assistance Program (the "Program"), the undersigned (the "Producer") grants, conveys and releases to the University of Tennessee, Center for Industrial Services (the "Department") all rights and title to the information provided in this application for purposes associated with the Program and the Department.

In addition, the undersigned agrees to release, indemnify and hold harmless the Department, its agents and assigns, from any loss or liability, without limitation, resulting in any way from or to the Producer as a result of participating in the Program.

* By checking this box, I have read the above and waive all claims against the Center's personnel and its host organizations. I understand that there are no warranties or assurances in connection with any assistance offered by the Center.

* Initials (required) :
* Title :
* Date : / /