Date: Supplier Information Form New Revision
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CLEAR FORM
Supplier Information Form
Date: New
Revision
Interested suppliers may complete and submit a Supplier Information Form to be included into LANS' vendor database. Suppliers are advised that there is no guarantee any solicitations or awards will be sent to Supplier by submitting a Supplier Information Form; however, in the event a solicitation is sent to the Supplier from an LANS Procurement Official, then a more formal quotation/offer may be required.
Legal Business Name:
D/B/A: (if applicable)
Business Phone: Address 1: Address 2: City:
Company Website:
State:
Zip Code:
Country:
Registered with System for Award Management ()?
Yes
No If yes, valid thru:
Type of Organization: ( Check all that are applicable)
Sole proprietorship Partnership Corporation Limited Liability Company Educational Institution International Organization
Non-profit organization Government Entity
Federal State Local
Joint Venture Individual Other (describe below)
Socioeconomic Status: (Please select one)
Large Business
Small Business
Select all that apply: Please note that 8(A) and HUBZone certifications come from the Small Business Administration (SBA).
Small Disadvantaged Women-Owned Small Veteran-Owned Small Service Disabled Veteran-Owned Small Indian-Owned Small
Alaska Native or Tribal Corporation 8(a) Small Business HUBZone Small Joint Venture
Individual Other (specify below)
Do you have an online catalog? Yes No Description of Services and/or Supplies offered:
GSA Contract? Yes
No
North American Industry Classification System (NAICS) Codes:
Company POC (Name) Title: Email: Phone #: Cell #: Fax #:
(SBPO 1/31/14)
SEND COMPLETED FORM TO:
Los Alamos National Laboratory Attn: Small Business Program Office
PO Box 1663 / MS P222 Los Alamos, NM 87545
Email: business@ Phone: (505) 667-4419
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