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Members sign-up
1. Company Information:
Company Name:
Address1:
Company Contact:
Address2:
DBA Name:
Phone:
Fax:
Owner Name:
Email:
City:
State:
Select
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zipcode:
Website Url:
Federal I.D.#
Dun & Bradstreet Number:
Password:
Membership Level:
Select
Individual $75
SmallBusines $200
Non-Profit $300
Cty, Gov, Fed Agency $750
VRP Membership:
Select
YES
NO
2. Business Classification:
Class :
Select
African American
Asian American
Hispanic American
Native American
Caucasian American
Vietnam Erea Vetreran
Disabled Veteran
Person With Disability
Other Specify Below
Gender:
Select
Male
Female
Other:
Business Type:
Select
Construction
Distributor
Information Technology
Manufacturer
Retailer
Reseller
Service Provider
Other (specify Below)
Category:
Other:
Certification Name 1:
Select
DGS SMALL BUSINESS
DVBE
HUBZONE
NMSDC
SMUD W/MBE
SBA 8a
SDB
SMUD W/MBE
Expiration:
Certification Name 2:
Select
DGS SMALL BUSINESS
DVBE
HUBZONE
NMSDC
SMUD W/MBE
SBA 8a
SDB
SMUD W/MBE
Expiration:
Certification Name 3:
Select
DGS SMALL BUSINESS
DVBE
HUBZONE
NMSDC
SMUD W/MBE
SBA 8a
SDB
SMUD W/MBE
Expiration:
State Contract Vehicle:
Expiration:
Federal Contract Vehicle:
Expiration:
3. Business Offerings:
Product Offering 1:
200 Characters Or Less
Product Offering 2:
200 Characters Or Less
Primary NAICS:
Secondary NAICS:
SIC Code:
SIC Code:
Product Offering 3:
200 Characters Or Less
Tertiary NAICS:
SIC Code:
Business Reference 1:
Phone:
Project Description 1:
200 Characters Or Less
Business Refference 2:
Phone:
Project Description 2:
200 Characters Or Less
Business Reference 3:
Phone:
Project Description 3:
200 Characters Or Less
If you want to be considered for our member of the Virtual Resource Platform and take advantage of procurement opportunities with our partners, please select "yes" under VRP membership and then complete sections 2-4 before submitting registration
4. Financial information:
gross annual sales Revenue for the past (3) years (example: 10,000)
2003:
Legal Structure:
Select
Corporation
Limited Liability Co.
Sole Proprietor
Sub Chapter
Partnership
Non-Profit
2002:
Number Of Employees:
Select
0-5
6-10
11-25
26-50
51-100
Over 100
2001:
Gegraphic Area:
Select
Local
National
International
Bonding Capacity:
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Broadband Survey
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