U.S. Department of Commerce

Small Business
Registration Form

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Contact Information

Company Name:

Address:

    

Contact Person Info:
Name:
Phone Number:
E-mail:
Website:

Company Information

Type Of Small Business (mark all that apply)
   Native American  Veteran Owned
     Disadvantaged Business  8(a) certified
   Woman-Owned Business  HUBZone certified
   Service-Disabled Veteran Owned  Other   
 
On Federal Schedule?
     No        Yes - Contract Number
 
Note: The PSC Codes and NAICS codes listed in the drop-down menus below reflect the services the Census Bureau most often requires. If there is a code for a service that your company provides that is NOT listed, and you think it could benefit the Census Bureau, please list it in the "Brief Capabilities Statement" section at the bottom.
 
Product/Service Classification (PSC) Codes  (Hold down the "Ctrl" button for multiple selections.)
 
  Product/Service Classification (PSC) Codes
 
NAICS Code(s)  (Hold down the "Ctrl" button for multiple selections.)
 
  NAICS Codes
 
Brief Capabilities Statement (Limit 2000 characters)
  Please include 3-5 past performance contracts you have worked on successfully for other
  government agencies or private industry.

characters left


Source: U.S. Census Bureau
Acquisition Division Last Revised: February 21, 2013