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Research grants (SBiR/STTr)

Service Application


Tennessee SBIR Proposal Assistance Center Service Application

Required fields are in Bold

Company Name: Point of Contact:
Work Number:

Title/ Position
Cell Number: E-mail Address
Fax Number: Web Address
Business Owner



   
       
Mailing Address
Address:    
City:

State:
Postal code:    
       
Location Address (if different from mailing address)
Address    
City State:
Postal Code    
 
What Products and Services do you offer? If not currently in production or operation, what is your area?
Have you identified a specific SBIR Topic or Agency?

 

Have you submitted a previous SBIR Proposal?
If yes, which agency/agencies?
Business Type: Manufacturer
Service
R&D
Not yet in Business		 Organization Type:
Business Size: Disadvantaged small
8(a)
SDVO small business
Woman-owned small
Other small
Large		 Business Range: Entire US
Southeastern US
Tennessee Only
International
Annual Sales ($)(3 Year Average):
Employees
State of Incorporation: Date Established:
Formalized Business Plan:



Government Qualified Accounting System:


SIC/NAICS Codes:
DUNS Number: Tax ID No.
Cage Code:
Federal Supply Codes/Product Service Codes
Ethnic Group: American Indian
African American
Caucasian
Asian/Pacific
Hispanic		 Military Status: Veteran
Vietnam-era veteran
Disabled veteran
Non-veteran
HUB Zone:
Certified
Are you in a HUB Zone?  
Referred By:
Do you have and existing relationship with ORNL or UT?
Has this company been debarred from performing federal contracts?

I request business management assistance from the Tennessee SBIR Proposal Assistance Center. I agree to cooperate should I be selected to participate in surveys designed to evaluate these services. I authorize the Center to furnish relevant information to the assigned counselor(s), with the expectation that information is to be held in strict confidence. I further understand that all counselors have agreed not to (1) recommend goods or services from sources in which they have an interest not to (2) accept fees or commissions developing from this procurement-relevant counseling relationship.

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.