SCOIN Intake Form

Business Designations:

Please select all that apply.

8a Small Business

Economically Disadvantaged Woman-Owned Small Business

HUB Zone Certified Company

Minority-Owned Small Business

Native American-Owned Business

Service-Disabled Veteran-Owned Small Business

Small Disadvantaged Business

Veteran-Owned Small Business

Women-Owned Small Business

Other - Business Designation:

Please list any not included in the above list.

DUNS Number (if known):

NAICS Code(s) (if known):

Primary Products Produced (1)

Primary Products Produced (2)

Primary Products Produced (3)

Primary Products Produced (4)

Other - Industry Sectors Served:

Please add any not included in the list above.

Other - Certifications:

Please list any not included in the above list.

Specialty Machinery, Capabilities, Capacities or Expertise:

Please include any additional information you'd like to share.

If you would like to receive information about supply chain opportunities that meet your capabilities/capacities; what size contracts (in dollars) would you consider exploring?*

Minimum:

Maximum:

*Please note that you will not be obligated to take action on any opportunities provided to you. Should you choose to respond, there is no guarantee that you will be selected. Your information will be provided to the requesting company(ies) via the national supplier scouting network. If you are chosen as a potential match, you will receive further information.