APPLICATION

 WIRING THE BORDER PROJECT

Prior to application you should review the selection criteria, also on this web site, to make sure your company can comply with all of the requirements.

BUSINESS INFORMATION

1) Name of Firm:
2)

Address:
2a) City
2b) State
2c) Zip Code
3) Owner:
4) President/CEO:
5) Telephone Number:
6)  Fax Number:
7) E-Mail Address:
8) WWW Page:
9)

Contact Person:
10) Year Established:
11) Average Number Of Employees:
12) Gross Revenue:

OWNERSHIP INFORMATION

13)

Legal Structure:

14) US Citizen:

Yes No

15) Minority Yes No
16) Currently 8a contractor Yes No
17) Other: WBO 
Veteran
Service Disabled Veteran
Vietnam Veteran
18) HUB Zone Certified:
19) Current Principals:

PRODUCTS AND SERVICES INFORMATION

20) Describe your Firm’s Capabilities:
21) Business Types & Percentages Construction %
Manufacturing %
R&D %
Service %
22) SIC Codes:
23) Quality Assurance Standards:

OTHER

24) Do You use computers at your business ? Yes No
If Yes:
24a) What Operating System (s) do you use ? WINDOWS 95/98
WINDOWS NT  
OTHER
24b) Do You use the Internet ? Yes No
24c) Do You use E-Mail?  Yes No
24d) Do You Have A LAN (Local Area Network)?   Yes No
25) Do You currently Export?  Yes No
25a) If so, where
26) Are You interested in participating in a Mentor/Protégé Program? Yes No
27)

Provide Customer Information by Client/Company and briefly describe type of work performed over the past two years.

28)

Your Name: 
29) Your Title:
30)

How did you find out about Wiring the Border?

This is phase one of your application process.  If you are selected for final consideration additional information will be required such as financial, tax, business plan documentation and so on.

Prior to application you should review the selection criteria, also on this WEBSITE, to make sure your company can comply with all of the requirements.