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Partner Information Data Form

* Fields with an asterisk are mandatory.

Company Information

Legal Name *
D/B/A
Address 1 *
Address 2
City * State
Postal Code * Country *
Main Phone * Main Fax
Website *

For United States Based Firms

DUNS # * Registered in CCR Database?
Federal TIN *
Type *
SB Designation
8(a) Certified

NAICS Code and Industry Title:

NAICS Code and Description:


Selected Value(s):

Add

Parent Company (if Applicable)
Legal Name
D/B/A
Address 1
Address 2
City State
Postal Code Country
Main Phone Main Fax
Website

Executive Leadership (Names)

CEO President *
Vice President CFO

For United States Based Firms

DUNS # Registered in CCR Database?
Federal TIN

Point of Contact

Primary

Title *
First * M.I.
Last * Position *
Address 1 *
Address 2
City * State
Postal Code * Country *
Phone * Fax
Mobile Other
Email *

Business Development

Title
First * M.I.
Last * Position *
Address 1 *
Address 2
City * State
Postal Code * Country *
Phone * Fax *
Mobile Other
Email *

Financial Information

Primary Contact

Title
First M.I.
Last Position
Address 1
Address 2
City State
Postal Code Country
Phone Fax
Mobile Other
Email
Annual Revenues Cost Recovery Method
# of Employees

Company Experience

Developing Country Experience in the Last Five Years

Region:

Country:


Selected Value(s):


Add

Technical Experience

Sector:

Subsector:


Selected Value(s):


Add

Donor Agency Experience

Donor Agency:

Company Description

Primary Service Offerings

 
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