POTENTIAL SUPPLIER PROFILE ATLANTIC MARINE To: All Suppliers and Potential Suppliers In accordance with Government regulations and prime contract requirements, we are required to get written representation of the business size and classification of our suppliers and subcontractors, as well as confirm their registration with the U.S. Department of Defense Controlled Goods Program. We ask your cooperation by completing and returning this form as soon as possible. If you do not have e-mail capabilities, fax this form to 904-251-1888. Our Company Offers an Accelerated Payment Plan for Companies which elect to participate. For participating companies we will pay invoices within (10) days of receipt. We wish to participate and will submit all invoices as required. Please pay us 2/10. We do not wish to participate in the APP. Please pay us net 45 days. For your convenience a W-9 form and instruction is included with this page and should be returned with your application along with the other forms listed below that apply. Failure to provide this information may delay payment. Form W-9 (signed and dated) Tax ID # ______________________________________ Subcontractor Prequalification Package (if applicable) Credit reference sheet Sales or use tax permit Company Name: ____________________________________________________________________________________ Mailing Address: ____________________________________________________________________________________ City: ______________________ State: ______ Zip Code: ___________ Fax: ____________________________ Country: _________________________________________ Employer Identification Number (required): ______________________________________________________________ Contact Person: _________________________ Title: ______________________ Phone numbers: _________________ E-mail Address: ____________________________________________________________________________________ Please check one: Corporation Partnership Sole Proprietorship Joint Venture Franchise Type of Business/Commodity/Service Check all that apply Broker Construction Contractor Consultant Freight Transportation Manufacturer Manufacturer Rep. Professional Services Retailer Distributor Dealer Service Provider Wholesaler Other Business Indicator: Large Minority Owned Woman Owned Veteran Non-Profit Small Disadvantaged Certified Hub Zone HBCU/MIS Other Foreign Certified Disadvantaged Native American Services Disabled Veteran Authorizing Person: Name: ___________________________________________ Title: ____________________________________________ Date: _________________________________ Phone Number: ______________________________________________ To find more about Atlantic Marine please visit our web site at

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