Partnership / Alliance Information:

Please enter your organization's information as completely as possible.
Note: PSS will never release your information to 3rd parties without your permission.
Partner Information:
COMPANY:     TAX ID NO.:  
DIVISION:     NAICS Code(s):
   
Enter NAIC codes separated by comma(s) (,)
COMPANY
DESCRIPTION:
   

Address IInformation:
Line 1:  
Line 2:  
Line 3:  
City:  
State:  
Zip Code:  
Remit to Address (if different):
Line 1:  
Line 2:  
Line 3:  
City:  
State:  
Zip Code:  

Primary Contact Name:  
Email Address:  
Phone:  

Partner Business Type
  Sole Proprietorship
  Partnership or LLP
  Corporation or LLC
  Other
Is this entity a NONPROFIT ORGANIZATION?:  YES  
Is this entity FOREIGN OWNED?  YES  
If this entity is an affiliate or subsidiary, please indicate:  Subisidary    Affiliate  

Parent Company Information*:
* - If applicable
Parent Company Name:  
Line 1:  
Line 2:  
Line 3:  
City:  
State:  
Zip Code:  
Is This Entity a:
Small Business?
Woman owned Small Business?
Veteran-owned Small Business?
Svc Disabled Veteran-owned Small Business?
HUBZONE Small Business?


Certified SBA SMALL DISADVANTAGED BUSINESS Information:
Is this entity a SMALL DISADVANTAGED BUSINESS with CERTIFICATION from the US Small Business Administration (SBA)??  YES    NO  
If YES, check the appropriate category:
Native American (e.g, American Indian, Eskimo, Aleut and Native Hawaiian)
Black American
Hispanic American (e.g., So. American, Central American, Iberian Peninsula)
Asian-Pacific American (e.g., Burma, Thailand, Malaysia, Indonesia, Singapore, Brunei, Japan, China, Taiwan)