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Download the Application as a PDF
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Please complete the form below.
Company Name:
Business Owner(s):
Contact Name:
Title:
Physical Address
(City/State/Zip) :
Mailing Address
(if different than Physical Address):
City:
State:
Zip:
County:
Work Phone:
Cell Phone:
E-mail:
Fax:
Is this a dedicated
fax line?		 Yes   No
Website:
Indicate Tribal Heritage
of Owner(s):
Is this business located
on or near a reservation?

 Yes   No
Type of Tribal
Recognition:		 Federal   State   NAI Organization   Self-Certified  

General Information:
Tax ID Number
or SSN Number:
DUNS Number:
CAGE Code:
Number of Employees:
Annual Revenue ($):
CCR Registered? Yes   No
Type of Organization: Individual   Limited Liability   Partnership   Tribally-Owned
Corporation Incorporated in the State of: 
Business Size:
 Small Business   Other Than Small Business
Type of Ownership
(Check all that apply):
Veteran
 If Service disabled, check here:
Minority
Woman
Other
If Other, list here:
Certifications
(Check all that apply):
8(a)
HubZone
SDB
ISO/SEI/CMM
Check one category that
best describes your business:
IT Products
IT Services
R & D
Manufacturing
Publications
Communications
Wholesaler
Architecture/
Engineering
Management Consulting
Construction
Maintenance Services
Management Support Services
Other:
Where do you do Business? Nationwide International
List Specific State(s) or countries:
Provide a brief description
of your business:
List any information about
your company that you would
want a potential customer to know:
List NAICS Codes applicable
to your business:
List PSC or FSC Codes
applicable to your business:
List any KEY WORDS (phrases,
acronyms, part numbers, etc.) pertinent to your business.
This will assist with
appropriate Bid Matches.

Example: (Client: XYZ Office Supply
Company, Common Key words: "Office Supplies" "paper printing binding" "office furniture")

By submitting this form, you are agreeing to the following:

I request procurement and technical assistance services in doing business with the Federal, state or local government from Procurement Learning for American Indian Nations & Societies. I agree to cooperate to participate in a brief annual survey designed to evaluate PLAINS consulting services. I authorize PLAINS to furnish relevant information to the assigned counselors and understand this information will be held in the strictest confidence.

I further understand that all PLAINS counselors have agreed not to: (1) recommend goods or services from sources in which he/she has an interest and (2) accept fees or commissions from this counseling relationship. In consideration of PLAINS furnishing technical assistance, I waive all claims against PLAINS personnel and its host organizations arising from this assistance.

 
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