Northeast Ohio PTAC
Intent to Receive PTAC Client Services

  * Colored Fields are required
Company Name:
Point of Contact:
Position Title:
Physical Address:
City:
State:
Zip:
County:
Same as Physical Address:
Mailing Address:
City:
State:
Zip:
County:
Work Phone:
Fax:
Cell Phone or Pager:
E-Mail Address:
URL/Web Address:
Avg # of Employees (last 3 yrs):
Avg Yearly Gross Sales (last 3 yrs):
Date Business was Established:    [YYYY-MM-DD or MM/DD/YY]
DUNS Number:
CAGE Code:    Search for your DUNS Number and CAGE Code
Owner's Years Experience in Field:
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
Distressed
Certified HUBZone
Small Business

Have you previously done business with any government agency or prime contractor?
Yes No Don't Know
 
Generally describe or list the Products or Services you wish to offer to the government:
 
List the types of services you might want to receive from our center:
 
How did you hear about us?
    Other:

 
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 Service Commitment then click Submit to complete your Intent to Receive PTAC Client Services.