Small Business Development Form

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Small Business Development Program

GSA

FIPS 201

Government - Small Business Development Program

Thank you for your interest in this program, which helps small businesses gain access to a wide array of government opportunities. We invite you to share your business qualifications, resources, and past performances with the government. Complete the form below and an ADT representative will contact you shortly.

* indicates required field

Company Information:

* Company Name:

* Tax ID#(TIN/EIN):

* Address 1:

Address 2:

* City:

* State/Province:

* Zip Code:

* Country:

* Company Web site URL:

Point of Contact(POC):

* BD POC First Name:

* BD POC Last Name:

* BD Email:

* BD Phone:

ext.
(example: 111-222-3333)

* President/CEO Full Name:

* President/CEO Email:

* President/CEO Phone:

ext.
(example: 111-222-3333)

Additional Key Office Locations:

Small Business Information:

* Small Business Classification:
(with certification date if applicable)

(Control+Click to select multiple)

If 8(a) is selected, please enter the Graduation Date:

If HUBZONE is selected, please enter the Certification Date:

If Small Disadvantaged Business is selected, please enter the Exit date:

* Key Capabilities:
(limit to 10 from drop-down menu provided)

(Control+Click to select multiple)

Other:

* Key Customers:
(limit to 6 from drop-down menu provided)

(Control+Click to select multiple)

List Specific Departments/Commands/Bases if applicable:

Keywords Summarizing Capabilities:

* Gross Revenue:
in US Dollars (3 year average)

* Number of Employees:

Year Founded:

NAICS Applicable Codes:

Special Certifications:

* Levels of Facility Clearances:

* Types of Cleared Employees:

* Previously Teamed with ADT:

ADT contact name if known:

Key Past Performance Brief:

* Customer:

Office/Agency/Department:

* Description of Work:

* Contract Amount:

* Prime or Subcontractor:

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