Small Business Supplier Information Form for KC-45 Tanker Program

* Indicates required field.

Indicate whether you are a new or current Northrop Grumman Integrated Systems supplier:
    New supplier Current supplier
Name of Northrop Grumman Buyer or referring individual:
Enter remittance address below.  Note if this is a change in address, a letter is required.
Company Name:*
Company Address:*  
     Congressional District:*
     Phone Number:*

Enter correspondence address below.
Company Name:
Company Address  
     Congressional District:
Identify sales contact for correspondence address.
Phone Number:*
FAX Number:*
Email Address:

Specify company details below.
     U.S. owned Foreign owned
Company is:
    division of:    
    affiliate of:    
    subsidiary of:
Type of business:*
    Manufacturing Distributor Service industry
Name of Principle Owner:*
Year of establishment:*
DUNS Number:*
NAICS code:*
Number of employees:*
Amount of last year's sales:
Major Product lines:*
(You may include your company's website address along with product information).
Major Customers:

The undernamed certifies that the above named company maintains a business classification as indicated below and that such classification is in accordance with all regulatory requirements related thereto. Further, it is understood and agreed that misrepresentation of the business classification is subject to penalties as prescribed in FAR 52.219.1.
Name of Certifying Official:*

Specify business classification.
    Small     Large
    If small is checked, check all of the following small business subcategories that apply:
       Certified Small Disadvantaged Business (please forward SBA certification letter)
       Small Disadvantaged Business (no SBA certification)
       HUB-zone Small Business (please forward SBA certification letter)
       Woman-owned Small Business
       Veteran-owned Small Business
       Service Disabled Veteran-owned Small Business
       HBCU/MI (Historically Black Colleges, Universities/Minority Institutions)
       Javitz Wagner O-Day Category
Specify ethnicity of principle owners.*
    African American
    Asian-Pacific American
    Hispanic American
    Other Minority
    Native American
    Subcontinent Asian American

Please remember to include any SBA certifications with your data submittal. If required, FAX to 310-335-4251.