NASA GMCI Application

First Name:
Middle Initial:
Last Name:
Job Title:
Company:
Address:
Address 2:
City:
State:
Zip/Post Code:
Phone:
xxx-xxx-xxxx
Fax:
xxx-xxx-xxxx
Email Address:
Web Site:
Other Contact:
Name of Primary Contact
(If not listed above):
  
Type of Business:
Company Description:
(Briefly describe company, product and services in 100 words or less)
Target Industry/Market:
Year Began Operations:
Management Team:
Number of Employees:
Annual Sales:
Annual Sales to NASA:
NASA Link: Prior    Existing
  SAA    SBIR    Contract    None
Desired Link to NASA:
Procurement Technology
Expertise Grant Funding
SBIR Testing Facilities
Business Plan Available: Yes    No
8a Certified: Yes    No
Minority Owned or Managed:

If yes, which minority group?		 Yes    No

Women Owned or Managed: Yes    No
How did you hear about GMCI?
Have you had previous contact with GMCI?

If yes, with whom?		 Yes    No