New Vendor Questionnaire General InformationCompany Name(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands DUNS NumberUnique Entity IdentifierCAGE CodeWebsiteYear Established:Number of Employees(Required)Select One…>5050-250250-500500-750<750Type of Business(Required)Select One…ManufacturerDistributorService ProviderOther (Please Specify)Core Capabilities(Required)Primary NAICS CodeSecondary NAICS CodesContactsPrimary Contact Name(Required)PositionPrimary Contact Phone Number(Required)Primary Contact Email(Required)Alternate Contact NamePositionAlternate Contact Phone NumberAlternate Contact EmailBusiness Size and ClassificationSelect those that apply:What is your organization's business type/socio-economic status? Small Business (no other socio-economic categories apply) AbilityOne Program Alaskan Native Corporation Disability Owned Economically Disadvantaged Woman Owned Business (EDWOB) Foreign Historical Black College or University (HBCU) Large Business Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTQ+) Minority Serving Educational Institution (MI) Native American Native Hawaiian Native Hawaiian Organization Non-Profit Agency SBA-certified 8(a) SBA-certified HUBZone Service Disabled Veteran Owned Business (SDVOSB) Small Disadvantaged Business (SDB) Tribally Owned Veteran Owned Large Veteran Owned Small Business Women Owned Large Women Owned Small Business (WOSB) Are you Minority Owned? Minority Owned Large Minority Owned Small If Supplier represented itself as either disadvantaged or minority-owned, (i.e., Small Disadvantaged Business; Economically Disadvantaged Women-Owned Small Business or Minority-Owned – Other Than Small Business), the supplier is requested to check the category in which its ownership falls. By checking one of the selections below, the supplier certifies that it has done so voluntarily. Untitled Black American Hispanic American Native American (American Indians, Eskimos, Aleuts, or Native Hawaiians) Asian-Pacific American Subcontinent Asian (Asian-Indian) American Individual/concern, other than one of the preceding Decline to answer Certifications and ComplianceManufacturing CertificationsISO 9001 Certified(Required) Yes No If yes, please upload certificationISO 9001 Certification(Required)Accepted file types: pdf, Max. file size: 50 MB.Only PDF format is acceptedISO 14001 Certified(Required) Yes No If yes, please upload certification ISO 14001 Certification(Required)Accepted file types: pdf, Max. file size: 50 MB.Only PDF format is acceptedAS9100 Certified(Required) Yes No If yes, please upload certification AS9100 Certification(Required)Accepted file types: pdf, Max. file size: 50 MB.Only PDF format is acceptedITAR Registered(Required) Yes No Cybersecurity CertificationsCybersecurity Maturity Model Certification (CMMC)(Required) Yes No CMMC LevelCMMC Level 1 (Self Assessment)CMMC Level 1CMMC Level 2CMMC Level 3CMMC Level 4CMMC Level 5NIST SP 800-171 Compliant(Required) Yes No Do you comply with DFARS 252.204-7012 (Safeguarding Covered Defense Information and Cyber Incident Reporting)? Yes No Do you have an SPRS NIST score?(Required) Yes No SPRS Score(Required)Is all of the information provided in this form represented on the System for Award Management (SAM.gov)?(Required) Yes No Untitled First Choice Second Choice Third Choice EmailThis field is for validation purposes and should be left unchanged. Δ
