information_request - The University of Texas-Pan American

Contact Person:

Alternate Contact:

Street Address:

Mailing Address:

City:

State:

Zip Code:

Phone:

Fax:

Legal Business Name:

Doing Business As (name):

E-mail:

Registrations

Has the firm been registered in either of the following?

SAM: Yes No

For SAM information, see www.sam.gov

Bid-Match: Yes No

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Organization Type

Sole Proprietorship

Partnership

Corporate Entity (Tax Exempt)

Corporate Entity (Not Tax Exempt)

International Organization

Business Type

(s)

8(a) Certified
Woman Owned Business
American Indian Owned
Minority Owned Business
Veteran Owned Business
Small Disadvantaged Business
Small Business
Construction Firm
Manufacturer of Goods
Service Provider
Other

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Date: (DD/MM/YYYY)

Time:

Request Submitted By:

Title:

Date:

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Information Request

General Information