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Getting Started - The New Client Questionnaire

NH-Procurement Technical Assistance Program (PTAP)

New Client Questionnaire
In order to secure PTAP services, the registering company must be located in New Hampshire. Information highlighted in red must be provided in order to complete and submit this questionnaire. However, all the information on this questionnaire and more is required in order to do business with the Federal Government. So, please take the time and provide all the information possible. Thank you, and if you have questions at any point, please give us a call.

 Contact Information
* First :    M.I. :    * Last :
* Title :
* Email Address :

 Company Information
Company Name :
* Mailing Address :
* Physical Address :
* City :
* State :
* Zip Code :
* County :
* Phone : ()-   Fax : ()-
Website :
* Tax Payer ID# :
* DUNS # :
Organization Type :
Corporation Partnership
Sub S Corporation Limited Liability
Sole Proprietor Non-Profit
State Incorporated :
Date Established : / /
Annual Sales : average of past three years

Principals
First :    Title :
First :    Title :
First :    Title :
Owner 1 :
Owner 2 :
Owner 3 :
US Citizen Owned :
yes no
Requires 51% or more of active ownership to be US owned.
Women Owned :
yes no
Disadvantaged Business Enterprise (DBE) Certified:
Certified :
yes no
Small Disadvantaged Business (SDB)/8a
Certified :
yes no
Veteran Business Development
Veteran :
yes no
Service Disabled :
yes no
Vietnam Veteran :
yes no
Hubzone Certified :
yes no

Other Business Data
Number of Full-Time Employees :
Number of Part-Time Employees :
Facility Square Footage :
Briefly describe the products or services you wish to sell to the government:
List all appropriate Standard Industrial Classification (SIC) Codes:
List all appropriate North American Industrial Classification System (NAICS) Codes:
List all appropriate Product Service Codes (PSC):
Central Contractors Registration (CCR)
Is your company registered on CCR?
yes no
Cage Code :
Complete PTAP Registration Form
By including your initials and clicking submit below, you indicate your agreement to the following: In consideration of inclusion in the Procurement Technical Assistance Program (the "Program"), the undersigned (the "Producer") grants, conveys and releases to the State of New Hampshire, Department of Resources and Economic Development (the "Department") all rights and title to the information provided in this application for purposes associated with the Program and the Department.

In addition, the undersigned agrees to release, indemnify and hold harmless the Department, its agents and assigns, from any loss or liability, without limitation, resulting in any way from or to the Producer as a result of participating in the Program.

COMPLETE NH-PTAP REGISTRATION

* Initials (required) :
* Title :
* Date : / /