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Company Profile Sheet

Filling out this form will allow you to sign up for PTAC's services.

Vitals
Company Name
Customer Name (Last, First, MI)
Position
E-Mail
Work Phone (xxx) xxx-xxxx
Fax (xxx) xxx-xxxx
Website
Business Size:
Sm-Dis
Other Small Business
Woman
Other Than Small Business
Business Type:
 Manufacturer
Retail Dealer, Type I
Construction
Surplus Sales		 Service Establishment
Retail Dealer, Type II
R & D
Not in Business
Organization Type:
 Individual
Non-Profit Organization
Limited Liability Co.		 Partnership
Corporation
Sub S Corporation
Incorporation State
Address
Mailing Address Information
Address
City

State

Zip Code
Physical Address Information
Address
City

State

Zip Code
County

Labor Surplus Area
HUBZone Certified
Address
CCR Registration
(MM/DD/YY)
Date Company Established
(MM/DD/YY)
PTAC
Federal ID
CAGE Code
DUNS Number
Annual Sales
Net Worth
Date
(MM/DD?YY)
Bonding
Amount
Warehouse Space (sq. ft.)
Manfacturing Space (sq. ft.)
Owners
Owners
Marketing Point of Contact
President
Vice-President
Secretary
Treasurer
# of Full Time Employees
# of Part Time Employees
  
Security Clearances
Key Personnel
Plant Personnel
Granting Agencies
SBA
Ethnic Group: American Indian/Alaskan Native
Black
Hispanic		 Asian/Pacific Islander
White or Other Minority
Military Status: Non-Veteran
Vietnam-Era Veteran
Disabled Vietnam Veteran		 Veteran
Disabled Veteran
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