Company/Prime Contractor:
Contact Name & Title:
Business Address:
(Street. P.O. Box, City, State, Zip)

Email Address:   Website:
Business Phone:       Cell Phone
Type of Business: Construction  Service  Retail   Warehouse     Other
Does your company have a Diversity Procurement or Supplier Diversity Program:  Yes    No
Average contract length:  1 Year      2 Year       As needed
Minority / Women Business Certification Requested?: Yes     No   Other
Assistance provided by your Company:    INVOICING     JOB ORDERS      OTHER

PRIME-CONTRACTOR REQUIREMENTS
Insurance (minimum requirement)  $   Bonding (minimum amount)  $
Number of years required in related field: (years)    References: (number required)