Small Business Classification Form

Business Classification Form

Business Classification & Certificate

NOTE: When you complete this information and press "submit", your information will automatically be entered into ManTech's small business database. This is the name & address that will be used on the purchase order unless the bidder (seller) makes any necessary changes in the name, address, or zip code.

* indicates required field

*Company's Legal Name:
*Address:
*City:
*State:
*Zip Code:
CAGE Code:
www:
Phone Number:
FAX Number:
*E-mail:

Type of Business (Please check all that apply)

Products Produced/Distributed of Services Performed:

	Manufacturer
	Distributor - Wholesale Retail, Warehouse
	Manufacturer's Representative
	Processor - Plating, Cleaning, Testing, etc.
	Construction, Installation, etc.
	Technical Publications & Graphics Producer
	Engineering - Research, Consultants, etc.
	Leasing Agency
	Other

Operating Under North American Industry Classification Systems (NAICS).

*Primay NAICS Code(s):

*Business Size/Type (select one only)

Small BusinessLarge BusinessForeign Owned (non US)Non-Profit

Business Ownership (select all that apply)

Women-Owned	Historically Black College/Minority Institute	HUBZone (Certified by SBA)
8a Program (Certified by SBA)	Small Disadvantaged (Certified by SBA)	Alaska Native Corporations (ANCs) and Indian Tribes
Veteran-Owned	Service Disabled Veteran-Owned

Number of Employees:

Provide the former name of company if there has been a change in ownership during the past year
Date of ownership change if applicable
*Authorized Signature
Title
Name Printed
*Date

Seller is advised that the U.S. Government may impose a penalty against a firm misrepresenting its business size and/or disadvantaged status. Eligibility as a small business is based on the regulations issued by the Small Business Administration in CFR 13, Part 121 of the SBA Rules and Regulations

For further information or questions, please contact:
Small Business Liaison Office
12015 Lee Jackson Highway, Suite 800
Fairfax, VA 22033
FAX: 703-218-6340 or e-mail: SBLO@ManTech.com

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