Supplier Registration Form

Office of the Comptroller of the Currency (OCC)
Supplier Registration Screen
Change klfOOnallOO

New Company Information

Company Legal Name: *

Company DUNS Number:

Company OBA Name:

*0

Is compilllY registered with SAM? (formerly CCR):

*0

I Yes
i_ I No

1

0

Please enter yo.u r company's five primary NAIC S (North American Industry Classification System) Codes (at least 1 is required):

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Please enter up to an additional 15 NA!CS Codes for your company (optional):

Company Address

Street Ac/dress:

*

Suite:

City:*

State:

Companv Phone Number:

Legal Entity Tyf}e:

*

•

Zip Code;

*

Website URL:

*

2

*

Business Classification (choose all that apply)

U

*

Small Busmess

Veteran Owned BJsiness
Service D1sab'ed Veteran O•imed Business

~I HUBZone Business
- I \~/omen

o,, 1ned Bl1siness
1

V\'omen Owned Small Business
.-, Econormcalty Disadvantaged V,/ornen Ovmed Small Business
Mmo,,ty Owned Business
_:_:i s--na!I D,sadvantaged Business

I

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Program Par:1c1pant

i'" _1 Subcomment Asian ::As1an-lnd1an) Amencan Owned
I-, As1an-Pacif1cAmerican o,,med
Back American Oi'med
H1spani-c American O:mec
Native Arr.erican 0-:;neC
A1asf:an Native Owned
1

American lndiari Ch', ned
1

Nati>;e ha•.va,ian O•;med
1nd1vidua1 ·:11th Oisab1lity· Owned Business

__ I Lesb,an Ga\.r Bise:,,ual orTransgencler Cvmed Business

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Capability Statement:

*

3000 characters remaining

Federal Contracting Vehicles (e.g. GSA ff Schedule 70; NIH NITAAC Cl0-SP3; NASA SEWP; etc.}:0

Contact Information

*

Contact Name: *

Title:

Contact Phone Number:

Email:

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