Supplier Information Form
D
ate:
New
Revision
Interested suppliers may complete and submit a Supplier Information Form to be included into LANS’ vendor database. Suppliers are advised that there is no
guarantee any solicitations or awards will be sent to Supplier by submitting a Supplier Information Form; however, in the event a solicitation is sent to the
Supplier from an LANS Procurement Official, then a more formal quotation/offer may be required.
Legal Business Name:
D/B/A:
(if
applicable)
Business
Phone:
Company
Website:
Address 1:
Address
2:
City:
State: Zip Code: Country:
Registered with System for Award Management
(SAM.gov)? Yes No
If
yes, valid
thru:
Type
of
Organization:
(
Check all
that
are
applicable)
Partnership
Corporation
Limited Liability Company
Educational
Institution
International Organization
Government Entity
F
ederal
State
Local
Individual
Other
(describe below)
Socioeconomic Status:
(Please select one
)
Large
Business
Small Business
Select
all
that apply:
Please
note that
8(A) and HUBZone certifications come
from the
Small Business
Administration (SBA).
Women-Owned Small
Veteran-Owned Small
Service Disabled Veteran-Owned Small
Indian-Owned Small
Alaska Native or Tribal Corporation
8(a) Small Business
HUBZone Small
Joint Venture
Other (specify below)
Do you have an online
catalog? Yes No
GSA Contract?
Yes No
Description of Services and/or Supplies offered:
North American Industry Classification System (NAICS) Codes:
Company POC
(Name) Title:
Email:
Phone #:
Cell #:
Events Attended
(if any)
SEND COMPLETED FORM TO:
Los Alamos National Laboratory
Attn: Small Business Program Office
PO Box 1663 / MS P222
Los Alamos, NM 87545
Email:
business@lanl.gov
Phone: (505) 667-4419
(SBPO 9/19/19)
