Form 3133-NEW NCUA Vendor Registration Form

NCUA VENDOR REGISTRATION FORM
Company Information
Company Legal Name
Dun & Bradstreet No. (DUNS)
Registered in CCR / SAM?

1

Yes

No

Company Address
Company City, State and Zip
Company Phone Number
Company Fax Number
Website URL

Company Industry Information
Primary Industry Code (NAICS)

2

Primary Supplies / Services Offered

Contact Information
Contact Person Name
Contact Person Title
Contact Phone Number
Contact Person Email Address

Legal Entity Type (Check one)
Individual / Sole Proprietorship

Business Classification (Check all that apply)
4

Non-Minority

Minority-Owned
3

Partnership
Subchapter S Corporation
Subchapter C Corporation
Limited Liability Corp (LLC)

Small Business
Woman-Owned
Veteran-Owned
Service Disabled Veteran Owned

African American
Hispanic American
Asian-Pacific American
Native American

Non-Profit
Foreign Corporation

HUBZone
8(a)

Asian-Indian American
Other (please explain)

5

Comments:

OMB 3133Footnotes:
1

SUBMIT

Expiration Date:

The Central Contractor Registration website (federal government contractors' registration website) has been updated and relabeled
under the System for Awards Management (SAM) at www.SAM.gov.

2
3
4

5
6

North American Industry Classification System - For your NAICS, enter keyword at http://www.census.gov/eos/www/naics/
A firm is a small business if its average 3-year revenue falls below the revenue size standard for its primary industry code.
A firm is minority-owned, woman-owned, or veteran / service disabled-owned, if it is at least 51% owned and controlled by
one or more individuals that are themselves minorities, women or veterans / service disabled veterans, respectively.
Asian-Indian : a U.S. citizen whose origins are from India, Pakistan or Bangladesh.

The NCUA may not collect this information, and you are not required to complete this form unless it displays a currently valid control
number. Estimated time to complete this form is 10 minutes.