Supplier Registration

General Information

* Indicates Response Required

*Company:

Division:

*Address 1:

Address 2:

*City:

State/Province:

*Zip/Postal Code:

*Country:

DUNS#(Dun & Bradstreet):

Controlled Goods #:

ITAR Control#:

Major certifications (ISO, CMMI, etc):

POC

* Indicates Response Required

*Last Name:

*First Name:

Title:

*Address 1:

Address 2:

*City:

*State/Province:

*Zip/Postal Code:

Phone:

Fax:

*Email Address:

*Citizenship:

Business Registration Information

*Please describe your potential offering to the program and address your competitive discriminator. (500 character limit):

Business Type (Check all apply)

 Small Medium Enterprise (SME) First Nation Other

Number of Employees

Annual Sales for last three years

2009 Sales $

2010 Sales $

2011 Sales $

Major Customers:

* Indicates Response Required