Full Business Name :

Business Address
Address:

City:

State:

Zip:


Physical Location
Address:

City:

State:

Zip:


Contact Person
* Name:

* Position:

* Contact Phone:

* Contact E-mail:

Contact Fax Number:


Business Type
Please select one:

Corporation
Partnership
Sole Proprietor
Other


Identification Numbers :
FEIN:

DUNS Number:


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:

In Pennsylvania:


* 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.

Institution Name:

Reference Contact Name:

Position:

Phone Number:

E-mail:


Institution Name:

Reference Contact Name:

Position:

Phone Number:

E-mail:


Institution Name:

Reference Contact Name:

Position:

Phone Number:

E-mail:


Please identify any contracts with the following:
(If so, enter your contract number below.)

Commonwealth of PA (DGS):

E & I Cooperative:

US Communities:

CoStars:

ProVista:

NJPA:

Other:

If other, please describe:


Please identify all eProcurement solutions you have implemented.

SciQuest
Ariba
Unimarket
ESM
Other

If other, please describe:


Conflicts of Interest
* Does any Gettysburg College employee serve as a director/officer of this company?

Yes
No


* Is any Gettysburg College employee a partner or sole proprietor of this company?

Yes
No


* Is any immediate family member (i.e. spouse or dependent child) of a Gettysburg College employee a partner or sole proprietor of this company?

Yes
No


* 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?

Yes
No


* Does any Gettysburg College employee hold any paid position in this company?

Yes
No


* Does any Gettysburg College Board of Trustee member serve as an officer or director of this company?

Yes
No


* 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?

Yes
No


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?