RFQ Addition.doc

In Addition To The Request For Quote, Please Provide The Following Information Date of Quote:

Company Name:

Business Address:

Phone Number:

Fax Number:

Contact Name:

Contact Email:

TIN/EIN Number:

DUNS Number: ______________ Are You Registered In The CCR?

Yes/No

(This MUST be verified by DUNS Number, so please be sure to complete that field above)

If NO, to register or learn more about the CCR go http://www.ccr.gov/. You MUST be registered in the CCR to be eligible for Award

Business Information: (please circle all applicable categories)

Small

Large

Women-owned Disadvantaged

Small Disadvantaged

Woman-Owned

8(a)

Service disabled/Veteran-owned small business Delivery Time:

Payment Terms:

FOB:

(Unless otherwise specified, all shipments will be FOB Destination) Do you accept Government Credit Card? Yes/No

Is price discounted for Gov’t: Yes / No

GSA Contract Number: _______________________

*** MAINTENANCE ***

(Please Complete The Following If Applicable)

Period of coverage: ___________________________________

Phone number for Technical Support (and contact person if applicable): ___________________________

Other phone numbers, if applicable:________________________ Days and hours of coverage: i.e. 24/7/365 (24 hours a day, 7 days a week, 365 days a year for technical assistance): _______________________________________________________________________

Includes – check all that apply

___updates ___upgrades ___fixes

Site visits: (please included how many, any travel costs, etc that apply) ___________________________ Other: (please give specific information including any additional costs

Please indicate whether maintenance begins after expiration of warranty, cited above, or at the time of delivery.

_____begins after expiration of warranty

_____begins upon delivery/acceptance of product