PARTNER ENROLLMENT

Please answer every question. If you believe a question does not apply to you enter "N/A".

1) Information
Company Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Phone:
Fax:
Company Website:
Contact Person:
Title:
Email:
Federal Tax ID #:
Dun & Bradstreet #:
Company Description & Services:
2) How is your business categorized for tax purposes?
S Corporation   LLC   C Corporation   Sole Prop./DBA
If Other, please specify:
3) Is your company classified as a small business enterprise, minority-owned or woman-owned business?
Yes     No
If yes, please identify the various types of certification granted to your firm (ie: 8a, Minority Business Enterprise, Local or State Government Office, etc.)
4) Have you previously worked with nfrastructure on any projects?
Yes     No
If yes, list customer(s) and location(s).
5) How long have you been in business?
6) Please list your revenues:
2017 Expected Revenue:
2016 Revenue:
2015 Revenue:
If you are qualified and invited to be a partner, we will require further financial and credit information.
7) Where are your offices located?
8) In which cities are you capable of providing resources?
9) How many employees do you have?
No. of Staff:
No. of Consultants:
10) How are your employees classified?
W-2 Only     1099 Only
Mix of both (explain):
11) How did you find out about nfrastructure?


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