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We have designed this registration page as a starting point for those companies who wish to be considered as a Teaming Partner for an opportunity.

Please begin this process by providing the following registration information. Once your application has been received, you will be contacted by a Partner Program Manager. To speak with someone directly about partnering with Avaya Government Solutions please contact Donna O'Hear (571) 643-4214.

* required fields

COMPLETING THIS APPLICATION FOR:


* Consideration as a teaming partner for an immediate opportunity?: Yes No
If for an immediate opportunity please provide details:
Date: 6/19/2013

COMPANY:


* Company Name:
Parent Company (if different):
* Address 1:
Address 2:
* City:
* State:
* Zip Code:
* Country:
* Company URL:
* Phone:
Fax Number:
Company Locations:

CONTACTS:


Primary Partnering Contact:
* Name (Last, First):
* Title:
* Phone Number:
Fax Number:
* Email:
Is contact address different than that above?: Yes No
If yes, complete additional address items:
Address 1:
Address 2:
City:
State:
Zip Code:
Country:
Primary BD/Sales Contact:
* Name (Last, First):
* Title:
* Phone Number:
Fax Number:
* Email:
Is contact address different than that above?: Yes No
If yes, complete additional address items:
Address 1:
Address 2:
City:
State:
Zip Code:
Country:
President/CEO:
* Name (Last, First):
* Title:
Other (i.e COO, V.P. Operations,
V.P. Sales, etc.)?:		 Yes No
* Phone Number:
Fax Number:
* Email:

COMPANY INFORMATION:


* Primary Business: IT Non IT
Hardware Software
Products Services
* Year company established:
State/Province/County of Incorporation:
Has company had a name change in the past 12 months?: Yes No
Previous company name:
* U.S. ownership?: Yes No
* U.S. headquartered?: Yes No
In which states and countries is business done?:
* Company Line of Credit?: Yes No
* Venture Capital-backed?: Yes No
* Does the company have a facility clearance?: Yes No
If yes, at what level?: Secret Top Secret
* Number of employees:
* Number of employees with security clearances:
* Company Fiscal Year:
* Last Fiscal Year revenue:
* Average 3 year revenue:
* Percentage of Revenue
from Government:		 20% 30%
50% 55%+
* Percent of Revenue from IT: 20% 30%
50% 55%+
CAGE #:
* DUNS #:
* Federal Tax ID # or EIN or Social Security Number (no dashes):
if SSN, Name of SSN owner:
* Company Differentiators: i.e. Gartner, SEI CMM, ISO etc.:
* Prime GWAC Vehicles?:
* GSA schedules?:

BUSINESS CLASSIFICATION: (select all that apply)


* Business Size: Large Small
* Business Type: Foreign-Owned Minority Owned
Women-Owned
Service Disabled Veteran Owned (VA Certification)
SDB 8(a)
HCBU HUBZone-(SBA Certification)
Native American
Alaska Native Corporation (ANC)
* Central Contract Registration (CCR) registry?: Yes No http://www.ccr.gov
Graduation/Exit date:

PRODUCTS AND SERVICES:


* NAICS Codes and US NAICS Title: (Please separate NAICS codes with a comma, e.g. 421610,421720, etc.):
* Core Capabilities:
* Products/Services:
* Give an overview of product/service offering:
Provide Key features/attributes associated with products/services:
* Key Discriminators:

EXPERIENCE AND REFERENCES:


* List five (5) Major Federal customers:



List geographic locations where work is being preformed:
Existing/Past Business with Government Agency:
Agency:
Contract Name:
Contract #:
Contract Value:
Date of Performance (Start, End):
Identify GWAC/GSA Schedule/vehicle (if applicable):
Contact Name:
Contact Phone:
Contact Email:
Business History with Avaya Government Solutions:
Existing/Past Business with Avaya Government Solutions?: Yes No
If yes, provide the following:
Contact Name at
Avaya Government Solutions:
Contract #:
Contract Value:
Date of Performance (Start, End):
Existing/Past Business with Commercial Companies:
Provide the following information for companies which you have done business with:
Company Name:
Contact Name:
Contact Title:
Contact Phone:
Contact Email:
Contract #:
Contract Value:
Date of Performance (Start, End):

Thank you for your interest in Partnering with Avaya Government Solutions

For More Information

Contact Avaya Government Solutions:

Main number:

Phone 1 703 653-8000
For Avaya Federal Solutions:
Phone 1 800 492-6769

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Partner Program Manager:

Phone (571) 643-4214
Donna O'Hear