BAA18_Cover_Sheet_for_Exploratory_Research.pdf

BAA18 Cover Sheet for Exploratory Research

White Paper/Proposal Contains Does Not Contain Proprietary Information

White Paper/ Proposal ID:

Research Topic Area: Solicitation Number:

Proposed Amount: Proposed Duration (in months): Anticipated Start Date (month/day/year):

Proposal Title:

Abstract (500 words or less)

Organization Information

Organization Name: Organization Address 1: Organization Address 2:

Organization City/Province: Organization State (2 letter designation):

Organization ZIP + Four:

Country:

Principal Investigator (PI)/Project Leader Information

PI First Name: PI Middle Initial: PI Last Name:

PI Address 1: PI Address 2:

PI City/Province: PI State (2 letter designation): PI ZIP + Four:

PI Phone (include area code): PI Fax (include area code): PI E-mail:

President/Company Officer/Technical Representative (For Business and Financial Matters)

First Name: Middle Initial: Last Name:

Address 1: Address 2:

City/Province: State (2 letter designation): ZIP + Four:

Phone (including area code): Fax (including area code): E-mail:

DUNS: TIN/EIN:

Banking Information

Bank Name: Bank Routing Number (ABA):

Swift (BIC - Bank Identifier Code; Applicable for Foreign Vendor Payments to non-US Banks):

Bank Account Number:

IBAN (Applicable for Foreign Vendor Payments to Non-US Banks):

Account Type (Checking/Savings):