First Name

Last Name

Email

Job title

Phone

Company

Website

DUNS Number

Address

City

State

ZIP

Country

Number of Employees

How long have you been in business (years)?

List your top 5 NAICS

Average Annual Sales

Do you Accept Credit Card Payments Do you Accept Credit Card Payments Yes No

Do you conduct business online? Do you conduct business online? Yes No

Brief explanation of your firms services or products

Is firm based in the United States? Is firm based in the United States? Yes No

Is firm a Small Business Is firm a Small Business Yes No

Is it a non-profit organization? Is it a non-profit organization? Yes No

SBA Certified 8(a) SBA Certified 8(a) Yes No

HUBZone HUBZone Yes No

EDWOSB EDWOSB SBA Certified EDWOSB Third-Party Certified EDWOSB No

WOSB WOSB SBA Certified WOSB Third-Party Certified WOSB No

SDVOSB SDVOSB VA Certified SDVOSB Third-Party Certified SDVOSB No

VOSB VOSB VA Certified VOSB Third-Party Certified VOSB No

Other designation not listed above

% of Revenue from Federal Government Business

Have you been awarded contract(s)with a federal agency? Have you been awarded contract(s)with a federal agency? Yes No

If yes, please provide a short description

How did you hear about FedMAP?

Type of Subscriber Type of Subscriber membership

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