Full Business Name :
Business Address Address:
Physical Location Address:
Contact Person * Name:
* Contact Phone:
* Contact E-mail:
Contact Fax Number:
Business Type Please select one:
Corporation Partnership Sole Proprietor Other
Identification Numbers : FEIN:
Business Profile :
* Check all that apply: Construction Concern Dealer with Inventory Stock Dealer without Inventory Stock Distributor Manufacturer/Producer Professionally Licensed Service Establishment Other
Primary NAICS Code:
Number of years in business:
Is your business a branch or subsidiary of another firm? Yes No
If yes, please specify parent company:
Estimated gross receipts/sales last year:
Number of employees: Company Wide:
At your location:
* Describe the types of equipment, supplies, material, and/or services you offer:
Provide URL for product catalog:
Provide URL for business website:
* Identify which College departments may benefit from your products or services: Athletics Bookstore Facilities Financial Services Food Services General Administrative Services Health Services Human Resources IT Lab Sciences Library Printing Residential Life Security Other
If other, please specify:
List the manufacturers or brand names your business distributes or produces:
University/College References Please provide the contact information for three colleges/universities that you have worked with previously.
Reference Contact Name:
Reference Contact Name:
Please identify any contracts with the following: (If so, enter your contract number below.)
Commonwealth of PA (DGS):
E & I Cooperative:
If other, please describe:
Please identify all eProcurement solutions you have implemented.
SciQuest Ariba Unimarket ESM Other
Conflicts of Interest * Does any Gettysburg College employee serve as a director/officer of this company?
* Is any Gettysburg College employee a partner or sole proprietor of this company?
* Is any immediate family member (i.e. spouse or dependent child) of a Gettysburg College employee a partner or sole proprietor of this company?
* Does any member of a Gettysburg College employee's immediate family (i.e. spouse of dependent child) have an ownership interest of 10% or more in this company?
* Does any Gettysburg College employee hold any paid position in this company?
* Does any Gettysburg College Board of Trustee member serve as an officer or director of this company?
* Does any member of a Gettysburg College Board of Trustee's immediate family (i.e. spouse or dependent child) have an ownership interest of 10% or more in this company?
If you answered yes to any of the above questions, please identify the specified individuals and describe their relationship to this company:
Any additional comments?
Campus Box 437300 North Washington StreetGettysburg, Pennsylvania 17325(717)337-6220
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