Intent to Receive PTAC Client Services

To register as a client with Kansas PTAC please read, complete all information below, and hit the "Submit Form" button. Kansas PTAC provides government procurement assistance to companies in the State of Kansas that have been in business for at least one year and have Internet access.

After submitting this form, please Email Kansas PTAC if we have not contacted you within 8 business days. Please feel free, however, to contact us in the meantime if you have any questions. We look forward to working with you.

  * Green Fields are required
Contact Name:
E-Mail Address:
Work Phone:
Cell Phone or Pager:
URL/Web Address:

Company Legal Business Name:
Position Title:

Physical Address:

Same as Physical Address:
Mailing Address:

Approximate Date Business Established:    [YYYY-MM-DD or MM/DD/YY]
DUNS Number:
CAGE Code:    Search for your DUNS Number and CAGE Code
No. of Employees (Full and Part Time):
Ownership Type:
Business Type:
Owner's Gender:
Current Business Status:
Business Ownership:
Check all that apply. (Defined as 51% owned and controlled.)
Woman-owned Minority-owned Veteran-owned
Service Disabled Veteran-owned
Business Certifications and Determinations:
Check all that apply.
Disadvantaged Business
Certified HUBZone
Small Business

What products / services do you offer?:

Does your company have any government contracting experience (local, state, or federal)?
Yes No Don't Know

Do you have any special quality standard designations? (ISO, etc.)?   Yes No

If "Yes" please list:  

Does your company have any other production or service locations?   Yes No

Where do you want to market your product or service?

Does your company accept credit cards?   Yes No
NOTE: Most government agencies purchase with credit card (VISA).

Is your company "Emerging Business Enterprise" (EBE) certified with the City of Wichita?
Yes No Don't Know

How did you hear about us?

Agreement of Understanding

By submitting this form I, the undersigned, certify that neither my company nor any of its officers appear on the Federal Government's Excluded Parties List. I realize that no contracts or sales can be guaranteed from Kansas PTAC services and that Kansas PTAC services are not to be considered legal advice or counsel. Completion of bids, offers, and pricing are the sole responsibility of my business / organization.

Kansas PTAC makes no representation or warranty as to the completeness or accuracy of any material or information provided. I agree that Kansas PTAC, its host organizations, and resource partners are not responsible for any consequential or any other damages arising out of or in connection with the use of any such materials or information. In consideration of the furnishing of services and technical assistance, I waive any and all claims against Kansas PTAC and its staff.

I agree that my organization will report information requested by Kansas PTAC regarding contracts / subcontracts obtained as a result of assistance provided from Kansas PTAC (directly or indirectly). Reports include Monthly Client Status Report, surveys, and success stories needed by Kansas PTAC in accordance with the Department of Defense. I understand that information provided to Kansas PTAC will be held in strict confidence and only provided to the Department of Defense as required and as appropriate to Congressional Offices to promote the program.

By submitting this form I understand and accept this Agreement.

Service Commitment
What to expect... What we expect...
  • Individualized business counseling
  • Support with bid proposals
  • Information on all government levels: local, state, and federal
  • Identification of bid opportunities
  • Registrations & Certifications
  • Training events
  • Networking / matchmaking events
  • Federal Acquisition Regulations
  • Procurement award history
  • Confidentiality concerning your company pertaining to any third party, with exception of our funding sources, without express consent by your company
  • Return our Survey
    • How is it going?
    • Any Contract or Subcontract Awards Information
    • Date(s) of Awards
    • Awarding Agency / or Prime
    • Contact Number
    • Location (state) Prime is located
  • Communications
    • Changes in your company's POC
    • Let us know your service needs
    • Updates in company capabilities
I understand that if the expectations of this Service Commitment are not met, PTAC reserves the right to change my status from Active to Inactive. By submitting this form, I certify the above information is correct.
 Please check this box to verify you agree to the Agreement of Understanding and the Service
Commitment then click Submit to complete your Intent to Receive PTAC Client Services.