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Get CPS Energy Business Questionnaire

FOR OFFICE USE ONLY V NAICS CODES ID CODE CPS ENERGY BUSINESS QUESTIONNAIRE Phone 210 353-2474 Fax 210 353-3021 Website www. cpsenergy. com Name of business Doing business as other business name if applicable Contact person and title Business mailing address City State Business telephone number - 4. Zip Code / Fax number Business e-mail address if applicable Is the above business name and mailing address considered the home office Yes No Size check one of the following Small Business or Large Business If you are having difficulty determining your size status please call SBA at 1-800-U-ASK-SBA or 202 205-6618 for assistance. Please check the following applicable boxes Certified by SBA as a HUBZone Small Business Woman Owned Small Business Woman Owned Large Business Veteran Owned Small Business Service Disabled Veteran Owned Small Business Small Disadvantaged Business not certified by the SBA Large Disadvantaged Business What is your ethnicity Black American Hispanic American Native American Asian Pacific American Subcontinent Asian American Historically Black College/Univeristy or Minority Institution Other Specify Number of Employees Primary NAICS Code If the NAICS Code is unknown please refer to www. sba*gov/size or provide a description of your materials and/or services so that we may provide the appropriate code for you Under 15 U*S*C. 645 d any person who misrepresents its size status shall 1 be punished by a fine imprisonment or both 2 be subject to administrative remedies and 3 be ineligible for participation in programs conducted under the authority of the Small Business Act. Printed name and Title Signature Date GOOD FOR ONE YEAR PERIOD. IT IS YOUR RESPONSIBILITY TO NOTIFY US IF YOUR SIZE OR OWNERSHIP STATUS CHANGES DURING THIS PERIOD. PLEASE LIST ON THE BACK OF THIS FORM OR AN ATTACHED SHEET ALL OTHER BUSINESS NAMES AND LOCATIONS THAT ARE AFFILIATED WITH YOUR FIRM E*G* BRANCH LOCATIONS ETC. Questions about this document should be directed to the phone number listed above or e-mailed to bsrogers cpsenergy. cpsenergy. com Name of business Doing business as other business name if applicable Contact person and title Business mailing address City State Business telephone number - 4. Zip Code / Fax number Business e-mail address if applicable Is the above business name and mailing address considered the home office Yes No Size check one of the following Small Business or Large Business If you are having difficulty determining your size status please call SBA at 1-800-U-ASK-SBA or 202 205-6618 for assistance. Zip Code / Fax number Business e-mail address if applicable Is the above business name and mailing address considered the home office Yes No Size check one of the following Small Business or Large Business If you are having difficulty determining your size status please call SBA at 1-800-U-ASK-SBA or 202 205-6618 for assistance. Please check the following applicable boxes Certified by SBA as a HUBZone Small Business Woman Owned Small Business Woman Owned Large Business Veteran Owned Small Business Service Disabled Veteran Owned Small Business Small Disadvantaged Business not certified by the SBA Large Disadvantaged Business What is your ethnicity Black American Hispanic American Native American Asian Pacific American Subcontinent Asian American Historically Black College/Univeristy or Minority Institution Other Specify Number of Employees Primary NAICS Code If the NAICS Code is unknown please refer to www. .

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