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      EnglishEspañolFrançaisKreyòlTiếng Việt简体中文한국어  Business and Organizations
              
              
                                                                                                                                                                                                                                                                                                                                                                              
                                                                                                                                                                                                    

              Doing Business with FEMA
                          Doing Business with FEMA

                      Vendor Profile Form
                  
                                        
                    
          
                    
                            
                                                    FEMA Small Business Program
                                                Provide Transport Services
                                                Advance Contracts of Goods and Services
                                                                      Frequently Asked Questions
                              
                                                                                      National Business Emergency Operations Center
          Industry Liaison Program Vendor Profile
Business Name
Business Website Address
Business Street Address
City
State
        - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming
County
ZIP Code
Date of Incorporation/Inception?
        This field cannot be a future date.
Point of Contact
Point of Contact Title
Point of Contact Email
Point of Contact Phone Number
Alternate Point of Contact
Alternate Point of Contact Title
Alternate Point of Contact Phone
Alternate Point of Contact Email
Which disaster are you interested in supporting?
        Hurricane Ian (DR-4673-FL)
Hurricane Fiona (DR-4671-PR)
Other
Other Disaster
Cage Code
        **Commercial and Government Entity (CAGE) Code**:
This code is assigned through System for Award Management (SAM). If you have not registered, please go to http://www.sam.gov to register prior to completing this form.
Unique Entity Identifier (UEI)
NAIC Code(s)
        Limit 5, separated by comma(s).
Is your product(s) or service currently on GSA schedule?
        Yes
No
Is your company currently doing business with FEMA?
        Yes
No
If yes, please list the name of the FEMA office(s)/person(s):
Please check all the categories that apply to your company.
        8(a) Certified
Disadvantage/Minority
HBCU/Minority Institution
Historically Under Utilized Business Zone (HUB Zone)
Native American
Service Disabled Veteran Owned Small Business
Small Business
Small Disadvantaged Business
Tribal
Veteran Owned Small Business
Women Owned Small Business
Other
Other
Please check applicable commodities(s)/service(s) your company provides
        Water
Food
Medical Supplies
Temporary Housing/Shelter
Infant Toddler Products
Generators
Blankets
Tarps
Cots
Other
Other
Please provide a brief description of your commodity(s)/service(s).
Does your company accept government purchase cards?
        Yes
No
Reason for contacting FEMA:
        General Inquiry
Vendor Presentation Meeting
Industry Day
Other
Other
Have you previously met with a program office or FEMA representative in the last twelve (12) months?
        Yes
No
If yes please provide that office(s)/person(s) name:
How did you find out about Industry Liaison?
        Website
FEMA Small Business
FEMA Representative Referral
Other
Other
FEMA Representative Referral Name
Completed by Name
        Name of person completing the form.
Completed by Email
        Email address of person completing the form.
**PRIVACY ACT STATEMENT**

**AUTHORITY**: 6 U.S.C § 796 "Registry of disaster response contractors"
Purpose: DHS/FEMA collects this information to facilitate communication between FEMA and the participants of FEMA's Industry Liaison Program.

**Routine Use(s)**: This information is used for the principal purpose(s) noted above. The information on this form may be disclosed internally within DHS as generally permitted under 5 U.S.C. § 552a(b)(1) of the Privacy Act of 1974, as amended, and will not be shared outside of DHS.

**Disclosure**: The disclosure of information on this form is voluntary; however, failure to provide the information requested may delay or prevent FEMA's sharing of information related to its Industry Liaison Program.


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