Request for Assistance

Please provide the following information so we can better serve you:
NAME
Title:	First:	Last:

COMPANY INFORMATION
Company Name:
Street:
Mail Stop/Floor:
City:	State: Zip:
Phones:	(Work) Ext:	(Mobile)
Email:
If your business has a web site, please provide the URL:
DUNS: Primary NAICS Code: Years in Business:

Socio-economic Designation:
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Is this your first contact with the
Heartland Office of Small Business Utilization? Yes No

PLEASE TELL US ABOUT YOUR BUSINESS

Help us help you by sharing pertinent information about your business.

Provide a brief description of your business:

(e.g., types of products or services provided, customers you do business with, etc.).

List government contracts your business currently holds:

(e.g., GSA Schedule, Multiple Award IDIQ, GWAC, etc. Include Contract Number(s))

Please list local small business events your business has attended in the past, or plans to attend in the future:

(e.g., Kansas City Small Business Networking Breakfast, etc.).

How can we assist you?

GSA Mobile