NETCOM MEETING WITH INDUSTRY Request Form

Form CSS

Industry Request Form

Company Name

Headquarters Address

Street

City

State/Region

Country

Zip

CAGE Code

Web Site

Industry Point of Contact/ Title

Email

Phone Number

Potential Visitors (List all)

Any Non US Citizens (Yes/No)

Purpose of Visit

Description of Topic

Do you have any contracts with NETCOM (Yes/No). If yes, please specify the contract number.

Are you currently bidding on any NETCOM contracts

YesNo

Do you have any pending claims, litigation, or other disputes with NETCOM (Yes/ No). If yes, please specify.

Do any visitors have existing restrictions associated with the Government meeting (E.g. cooling off period) (Yes/No)

Are you aware of NETCOM employees, military or civilian (or their spouses, children or other members of the household) who have personal connection to you or your non-Federal entity, to include previous employment, job offers, or submission of resumes? [Yes or No] If yes, what employee(s) and what is the connection

**Information Affirmation Form:**

By clicking the submit button, you affirm all information provided is true to the best of your knowledge.

Please ensure that all information submitted is accurate and up-to-date. Any inaccuracies or misrepresentations may result in your request being denied.

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