Idaho PTAC
Intent to Receive PTAC Client Services
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Company Name:
Point of Contact:
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Dr.
Mr.
Mrs.
Ms.
Rev.
Please choose...
II
III
Jr.
Sr.
Position Title:
Please choose...
N/A
CEO (01)
Employee (02)
Marketing Exec. (03)
Partner (04)
President (05)
Sales Exec. (06)
Secretary (07)
Sole Proprietor (08)
Treasurer or CFO (09)
Vice-President (10)
Congressional Rep (11)
EDC Professional (12)
Judicial Representative (13)
Legislative Representative (14)
State Representative (15)
Federal Rep. (16)
Other State or Local Rep. (17)
Other (18)
Banker (19)
SBA Rep (20)
Physical Address:
City:
State:
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Zip:
County:
Same as Physical Address:
Mailing Address:
City:
State:
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
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?
Please choose...
NA
Word of Mouth
APEX Accelerator
Bank
Newspaper
Chamber of Commerce
Internet
Radio
Televesion
Magazine
Other
SBA
SBDC
Business Owner
Educational Institution
Local Economic Development Official
Other Client
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
Communication
Meet with Idaho PTAC and receive at least 30 minutes of counseling time and/or attend a Idaho PTAC event every 12 months.
Changes in your company's POC
Let us know your service needs
Updates in Company Capabilities
Return our Survey
How is it going?
Report any Federal, State or Local Contract or Subcontract Awards Information
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.