If you prefer, you can print this page and fax it to (502) 564-5932.

Note: questions marked with an * are required.

1.) Client ID: (assigned by KPAP staff)
2.) * Company Name:
3.) * Company Contact Person:	First Name	M.I	Last Name
Please Choose One Mr Mrs Ms Dr
Either a phone number, fax, OR e-mail address is required
4.) E-mail address:
5.) Phone:
6.) Fax:
7.) * Business Size Classification: Please Choose One Disadvantaged Small Disadvantaged & Woman Owned Small Woman Owned Small Small Large
8.) * Primary Business Type: Please Choose One Manufacturer Service Retail Wholesale/Dealer Research & Development Construction
9.) * Organization Type: Please Choose One Sole Proprietorship Partnership Non-Profit Organization Corporation Limited Liability Co. Subchapter S Corporation
10.) * Mailing Address:
Address 2:
City:	State:    Zip:
11.) *Street Address: check if same as Mailing Address
Address 1:
Address 2:
City:	State:    Zip:
12.) Is this location in a HUBZone?		YesNo Find Out if you are in a HUBZone
13.) *County (physical location of business): Please Choose One ADAIR ALLEN ANDERSON BALLARD BARREN BATH BELL BOONE BOURBON BOYD BOYLE BRACKEN BREATHITT BRECKINRIDGE BULLITT BUTLER CALDWELL CALLOWAY CAMPBELL CARLISLE CARROLL CARTER CASEY CHRISTIAN CLARK CLAY CLINTON CRITTENDEN CUMBERLAND DAVIESS EDMONSON ELLIOTT ESTILL FAYETTE FLEMING FLOYD FRANKLIN FULTON GALLATIN GARRARD GRANT GRAVES GRAYSON GREEN GREENUP HANCOCK HARDIN HARLAN HARRISON HART HENDERSON HENRY HICKMAN HOPKINS JACKSON JEFFERSON JESSAMINE JOHNSON KENTON KNOTT KNOX LARUE LAUREL LAWRENCE LEE LESLIE LETCHER LEWIS LINCOLN LIVINGSTON LOGAN LYON MADISON MAGOFFIN MARION MARSHALL MARTIN MASON MCCRACKEN MCCREARY MCLEAN MEADE MENIFEE MERCER METCALFE MONROE MONTGOMERY MORGAN MUHLENBERG NELSON NICHOLAS OHIO OLDHAM OWEN OWSLEY PENDLETON PERRY PIKE POWELL PULASKI ROBERTSON ROCKCASTLE ROWAN RUSSELL SCOTT SHELBY SIMPSON SPENCER TAYLOR TODD TRIGG TRIMBLE UNION WARREN WASHINGTON WAYNE WEBSTER WHITLEY WOLFE WOODFORD
14.) Date Business Started:  (mm/dd/yyyy)
15.) Company Website:
16.) * Federal Congressional District: Please Choose One 1 2 3 4 5 6
17.) DUNS# (number only - no dashes or spaces):
18.) CAGE Code:
19.) * Military Status of Owner: Please Choose One Non-Veteran Veteran Service-Connected Disabled Veteran
20.) SIC (Standard Industrial Classification) codes (list primary code first - 480 characters maximum):
21.) NAICS (North American Industry Classification System) codes (list primary code first - 480 characters maximum):
22.) FSC/PSC (Federal Supply Class/Product service Class) codes (list primary code first - 480 characters maximum):
23.) * Description of company's products or services - 480 characters maximum (Please be as specific as possible; the keywords you list here will be used to help us match your company's capabilities and interests with government contract opportunities. List all keywords that describe your products/services. Use the "Comments" section below if additional space is needed.):
24.) Geographical marketing area of your firm (i.e., where do you want us to search for government contracting opportunities; list states; or if less than statewide, list specific cities/counties to be searched. To search all states, enter 'nationwide') - 480 characters maximum:
25.) Comments (480 characters maximum):

Click the "Submit" button above to send your information electronically.

If you prefer, you can print this page and fax it to (502) 564-5932.

If you have any questions, please e-mail us or call us at (800) 838-3266.

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