GSA 5 YEAR CONTRACT REGISTRATION PROFILE FORM

GSA 5 YEAR CONTRACT REGISTRATION PROFILE FORM

DBA: Physical Address: Mailing Address:
Phone:
Fax:
Website:
Primary Contact:
Title:
Email:
Phone:
Cell:
Alternate Contact :
Right to Sign for Company? :
DUNS Number:
Tin:
Fiscal Year Begins:
Fiscal Year Ends:
# of Years in Business:
SAM Registered?:
Do you have Invoices/Contract from within the last 12 months to support the Products/Services to be Offered?:
Type of Organization:
Are you a Manufacturer?:
If you are not the manufacturer of the Products to be Offered, can you obtain Letters of Supply from your manufacturer? :
Offering to GSA:
Please provide a brief description of your commodity(s)/service(s).:
Signature:
Date: