Belt Collins encourages and promotes the use of small (SB), small-disadvantaged (SDB), woman-owned (WOSB), HUBZone (HUBZone SB), veteran-owned (VOSB), and service-disabled veteran owned (SD-VOSB) businesses. As a prime contractor for the U.S. federal government, the firm recognizes its responsibility to not only maximize the subcontracting of small businesses, but also to provide the guidance needed to enable small businesses to take advantage of government contracting opportunities. To this end, the firm is proactively seeking to expand its database and improve its subcontracting program.

If you are a small business and would like to register your firm with Belt Collins to be considered for future subcontracting opportunities, please complete the following questionnaire.

Name: *

Company: *

Address: *

City: *

State: * select...ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYASDCFMGUMHMPPWPRVIAEAAAEAEAEAP

Country: *

Zip Code: *

Phone: *

Fax:

E-mail: *

Web-site:

Business Size: * select...Small Business ConcernLarge Business Concern

Business Type: * select...Not ApplicableSmall Business (SBC)Small-Disadvantaged Business (SDB)Woman-Owned Small Business (WOSB)HUBZone Small Business (HUBZone SB)Veteran-Owned Small Business (VOSB)Service-Disabled Veteran-Owned Small Business (SD-VOSB)

Minority Groups: * select...Not ApplicableBlack AmericanHispanic AmericanAsian-Pacific AmericanNative American (American Indians, Eskimos, Native Hawaiians)Other (as established by SBA from time to time)

NAICS Code(s): *

(North American Industry Classification System - web site)

Certified by: *

(Name of Officer Completing Form)

Date: *

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Year200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050

Title: *

Brief Description of Services: *

Note: SDB and HUBZone SB concerns need to be certified by the Small Business Administration. To obtain certification, please visit the SBA Web site. SBC, WOSB, VOSB, and SD-VOSB are self-certified.

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