Partnering With Nortel Government Solutions

We have designed this registration page as a starting point for those companies who wish to be considered as SDBPrime associates or as a Teaming Partner for an opportunity.

Please begin this process by providing the following registration information. Once your application has been received, you will be contacted by a Partner Program Manager.

*required fields

Completing this application for:

*Consideration as a teaming partner for an immediate opportunity?: Yes No
*Consideration for SDBPrime program?: Yes No
If for an immediate opportunity please provide details:
Date: 7/6/2008

Company:

*Company Name:
Parent Company (if different):
*Address 1:
Address 2:
*City:
*State:
*Zip Code:
*Country:
*Company URL:
*Phone:
Fax Number:
Company Locations:

Contacts:

Primary Partnering Contact:
*Name (Last, First):
*Title:
*Phone Number:
Fax Number:
*Email:
Is contact address different than that above?: Yes No
If yes, complete additional address items:
Address 1:
Address 2:
City:
State:
Zip Code:
Country:
Primary BD/Sales Contact:
*Name (Last, First):
*Title:
*Phone Number:
Fax Number:
*Email:
Is contact address different than that above?: Yes No
If yes, complete additional address items:
Address 1:
Address 2:
City:
State:
Zip Code:
Country:
President/CEO:
*Name (Last, First):
*Title:
Other (i.e COO, V.P. Operations,
V.P. Sales, etc.)?:		 Yes No
*Phone Number:
Fax Number:
*Email:

Company Information:

*Primary Business: IT Non IT
Hardware Software
Products Services
*Year company established:
State/Province/County of Incorporation:
Has company had a name change in the past 12 months?: Yes No
Previous company name:
*U.S. ownership?: Yes No
*U.S. headquartered?: Yes No
In which states and countries is business done?:
*Company Line of Credit?: Yes No
*Venture Capital-backed?: Yes No
*Does the company have a facility clearance?: Yes No
If yes, at what level?: Secret Top Secret
*Number of employees:
*Number of employees with security clearances:
*Company Fiscal Year:
*Last Fiscal Year revenue:
*Average 3 year revenue:
*Percentage of Revenue
from Government:		 20% 30%
50% 55%+
*Percent of Revenue from IT: 20% 30%
50% 55%+
CAGE #:
*DUNS #:
*Federal Tax ID # or EIN or Social Security Number (no dashes):
if SSN, Name of SSN owner:
*Company Differentiators: i.e. Gartner, SEI CMM, ISO etc.:
*Prime GWAC Vehicles?:
*GSA schedules?:

BUSINESS CLASSIFICATION: (select all that apply)

*Business Size: Large Small
*Business Type: Foreign-Owned Minority Owned
Women-Owned
Service Disabled Veteran Owned (VA Certification)
SDB 8(a)
HCBU HUBZone-(SBA Certification)
Native American
Alaska Native Corporation (ANC)
*Central Contract Registration (CCR) registry?: Yes No http://www.ccr.gov
Graduation/Exit date:

PRODUCTS and SERVICES:

*NAICS Codes and US NAICS Title: (Please separate NAICS codes with a comma, e.g. 421610,421720, etc.):
*Core Capabilities:
*Products/Services:
*Give an overview of product/service offering:
Provide Key features/attributes associated with products/services:
*Key Discriminators:

EXPERIENCE and REFERENCES:

*List five (5) Major Federal customers:



List geographic locations where work is being preformed:
Existing/Past Business with Government Agency:
Agency:
Contract Name:
Contract #:
Contract Value:
Date of Performance (Start, End):
Identify GWAC/GSA Schedule/vehicle (if applicable):
Contact Name:
Contact Phone:
Contact Email:
Business History with Nortel Government Solutions:
Existing/Past Business with Nortel Government Solutions?: Yes No
If yes, provide the following:
Contact Name at
Nortel Government Solutions:
Contract #:
Contract Value:
Date of Performance (Start, End):
Existing/Past Business with Commercial Companies:
Provide the following information for companies which you have done business with:
Company Name:
Contact Name:
Contact Title:
Contact Phone:
Contact Email:
Contract #:
Contract Value:
Date of Performance (Start, End):

Thank you for your interest in Partnering with Nortel Government Solutions