Small and Minority Business Contact Request Contact a professional who specializes in your commodity. Fill out this quick and easy form and a representitive will contact you and provide you with the answers you are looking for. Step 1 of 5 - Contact Information 20% HiddenPost Title Is this the first time completing this form for your company?* Yes No In order to complete this form, you may need the following documents ready to upload. DAS Certificate (Required), Capability Statement (Optional), Business Card (Optional). Vendor Name*DBA - Doing Business As Contact Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmail* Website Update Contact InformationPlease include only the information that has been changed.Vendor Name UpdateDBA - Doing Business As Contact Name Update First Last Address Update Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone UpdateEmail Update Website Update CommodityClick below to chose one or more areas of interest to you. To select more than one commodity, CTRL + Click each commodity (CMD + Click for MAC).Advertising and Marketing ServicesAgriculture Animals and SuppliesAgriculture ESS - except animalsAppliancesArchitectural and Engineering ServicesArt ESSAthletic ESSAudio Visual ESSAwards Plaques and TrophiesBinding and Framing ESSBooks Periodicals etcBuilding and GroundsCable TV and Fiber Optic CableCatering Conferences and HospitalityCharters - AirChemicalsClothing and Accessories - except uniformsCollection ServicesCompressed GasComputer MaintenanceComputer Peripherials and PrintersComputers Desktops Laptops ESSConcessions AthleticsConstructionConstruction-Related ServicesConsulting ServicesDry Cleaning and Laundry Equipment and ServicesDues Fees and RegistrationsEducational Abroad ProgramsEH and S Clean Air DevicesEH and S RadioactiveEH and S Restricted EquipmentEH and S Restricted Materials - BiologicalEH and S Restricted Materials - ChemicalElectronics - LabElevatorsEmployment Services TemporaryEnergy Management SystemsEnvironmental ServicesEvent ServicesExport Controlled ItemsExpress Mail ServicesFinancial and Banking ServicesFire Alarm ESSFlags and BannersFloor CoveringsFlorist ServiceFood ESSFood-Retail and BranchesFuelFurniture LabFurniture OfficesFurniture OtherGraphic ESSHardware - Facilities and ConstructionHazardous WasteHigh Performance ComputersHuman Resources ServicesHVACIndustrial ESSInsurance Health - StudentInternet Services ESSIT Consulting ServicesIT Network EquipmentIT TelecomIT TrainingJanitorial ESSLab and Class ESSLab AnimalsLandscapeLegal and Other Professional ServciesLibrary ESSLoan Services - StudentLocksmith ESSLodgingLumberMailing ESSMarine and Oceanography ESSMedical ESSMotor VehiclesMoving ServicesMROMusic ESSOffice ESSOn-Call Professional Services ProgramOn-Call Trade and General Contractors ProgramsOtherPaint ESSPaperPharmaceuticalsPhones and Mobile Phones ES and SPhotocopier and Copy Services ESSPhotographic ESSPlanning and Design ServicesPower Plant ESSPrinting ESSProfessional Design Services and PublicationsProfessional TrainingPromotional ItemsPublic Relations ServicesRadio and 2-Way RadioRegulated WasteRenovationsReprintsSafety ESSSatellite CommunicationSecurity Systems ESSServersService MaintenanceShredding ServicesSignageSoftware and MaintenanceSpace Rental (rooms, office space)Speakers and HonorariumsSprinkler Systems ESSStationeryStorage Containers - TrailersTeam TravelTheatrical ESSToolsToys Games and EducationalTranslation ServicesTransportationTrash and RecyclingTravel ServicesTuition PaymentsUniforms and FootwearVeterinary ESSVideographyWater - Cooler Rentals and SuppliesWebsite DesignWelding ESSWindow Treatments and TextilesConstructionOn-Call TradeAsphaltElectricalFlooringGeneral ContractorInsulationMasonryMechanicalPaintingRoofSiteOther Commodity Comments or Questions Are you a part of a Connecticut state contract or consortia?* Yes No Contract Name and/or Number* Supplier Diversity Certification(s) DAS NMSDC DOT WBENC SAM.GOV OTHER DAS Expiration Date* MM slash DD slash YYYY NMSDC Expiration Date* MM slash DD slash YYYY DOT Expiration Date* MM slash DD slash YYYY WBENC Expiration Date* MM slash DD slash YYYY SAM.GOV Expiration Date* MM slash DD slash YYYY OTHER Expiration Date* MM slash DD slash YYYY Cert TypeCharacteristics CTB (Connecticut Business) DISBE WBE MBE SBE OTHER Upload Supporting DocumentsDAS Supplier Diversity Certificate*Max. file size: 250 MB.GNEMSDC Supplier Diversity CertificateMax. file size: 250 MB.DOT Supplier Diversity CertificateMax. file size: 250 MB.WBENC Supplier Diversity CertificateMax. file size: 250 MB.Other Supplier Diversity CertificateMax. file size: 250 MB.Capability StatementMax. file size: 250 MB.Business CardMax. file size: 250 MB.How would you like to be contacted? Phone Email In Person Meeting Mail What makes your business unique?(optional)EmailThis field is for validation purposes and should be left unchanged.
