Client Information Form

Please provide detailed information about your business. This helps us expedite your government contracting registration and ensure accuracy.

Secure & Confidential•Takes 10-15 minutes

Business Information

Legal Business Name *

DBA Name (if different)

EIN (Employer Identification Number) *

Year Established *

Business Address *

City *

State *

ZIP Code *

Business Phone *

Business Email *

Website

Business Structure *

Annual Revenue *

Full Name *

Title *

Email *

Phone *

Ownership Percentage *

Social Security Number (Last 4 digits) *

I am a U.S. Military Veteran (VOSB)

Business is at least 51% owned by women (WOSB)

Business is at least 51% owned by minorities (MBE)

Business is located in a HUBZone

Business Description *

NAICS Codes (if known)

Don't worry if you don't know these - we'll help you identify the right codes.

Number of Employees *

Past Performance / Notable Projects

Which government levels are you interested in? *

Federal Government

State Government

Local Government (County/City)

Target States/Regions

Target Agencies (if known)

Anything else we should know?

By submitting this form, you authorize Near Me Marketing to begin your government contracting registration process.