D-U-N-S® Number Request

About You
Your Name*                                 Your Title*
  
Your EMail/Internet Address*               Your Phone Number* 
  


Company Identification
Company Name*                              Federal Employment ID Number 
  
Physical Street Address*                   City* 
  
                                           State*   ZIP Code*
                                                 
Mailing Address (if different than above)  State    ZIP Code
        
Telephone (General/Main Number)*           Fax Number
                 
General EMail/Internet Address
  

Does Your Company Have A Website? Yes

If So, What Is Your URL? 


                     
Operating Details
What Does Your Business Do?*
                     
How Many Total Employees?                  Annual Sales/Revenues
                           

Is Your Business (please check all that apply):
A Franchise Operation?    Yes 
An active exporter?       Yes
Interested in exporting?  Yes
An active importer?       Yes

Do Any of the Following Manufacturing Quality Assurance Codes
Apply to Your Business?
MIL-I-45208  Yes
MIL-Q-9858   Yes
Other 

Company Ownership & History
Principal/CEO Name*                        Principal/CEO Title*
  

When Did Your Business Start?
Month                    Year 
         

Is Your Business (check all that apply)
Minority Owned?        Yes    Ethnic Group(Check Only if Minority Owned)
Woman/Women Owned?     Yes    Asian   Indian Subcontinent
Veteran Owned?         Yes    Black   Native American
Disabled Veteran Owned?Yes    Hispanic  Other 
Vietnam Veteran Owned? Yes

Legal Structure (please check only one):
Proprietorship       Corporation 
Joint Venture        S Corporation 
Partnership          C Corporation

If your business is a corporation, please complete the following:
State of Incorporation      Incorporation Date
                         

Name of Officers/Shareholders Officer/Shareholder Title  Stock Ownership %
1)          
2)          
3)          

Is Your Business Owned By Another Company?Yes  Percent of Ownership:      
 
Parent Company Name                City/State        Business Operations
    

If your business is a partnership, please list all general partners:
Name of General Partners
1)  
2)  
3)  

Other Locations / Related Businesses
Please complete the following if applicable to your business.
Any Branch Locations?  Yes
Branch Addresses                   Employees at Branch   Business Operations
1)             
2)             
3)             

Any Subsidiaries?  Yes
Subsidiary Addresses               City / State      Business Operations
1)         
2)         
3)