First Name:

Last Name:

Company:

Address:

City:

State:

Zip Code:

Phone Number:

Fax Number:

E-mail Address:

Web Site Link:

Federal Tax ID Number:

Dun and Bradstreet Number:

Small Business: Please Select Yes No

Minority Owned: Please Select Yes No

Female Owned: Please Select Yes No

Description of Product/Service:
Contractors
Electric Equipment & Components
Environmental Services
Facilities Management
Fleet Management
Fuel, Chemicals & Industrial Gases
IT Hardware & Software & Services
Marketing & Sales
MRO
Natural Gas Pipeline (transmission & distribution)
Office Furniture & Supplies
Office Services
Other (non-sourceable)
Personnel
Power Generation Material
Professional Services
Telecommunications
Temporary Labor
Transportation & Distribution
Travel

Geographic area interested in serving (choose all that apply):
Bay State Gas
Columbia Gas of Kentucky
Columbia Gas of Maryland
Columbia Gas of Ohio
Columbia Gas of Pennsylvania
Columbia Gas of Virginia
Columbia Gas Transmission
Columbia Gulf Transmission
Columbia Retail Services
Crossroads Pipeline
Energy USA-TPC
Kokomo Gas & Fuel
NIFL
NIPSCO
NiSource Energy Technologies
Northern Utilities

Other utility customers currently serving:

References:

Comments: