Wisconsin Manufacturing Extension Partnership

Network Service Provider Profile

HomeNetwork Service Provider Profile

This form is extensive. Please review the required contents before starting to fill out the form to ensure you have all of the information ready before hitting "submit". An Excel version of the form is available on the Partner Page.

General Information
Include full name of organization and if it is a subsidiary, the name of the parent company
Organizational Information
What type is your organization?
If you selected Other, please describe.
How many people are employed by the organization?
What areas of Wisconsin does your organization serve?
Financial Information
What was your organizations annual sales revenue for your last fiscal year?
Financial Contact Name
Corporate Banking Firm Name
Corporate Banking Firm Contact Name
Bank Contact's Phone Number
Corporate bank street, city and state address
Federal Employer ID number (FEIN)
Fees
How do you typically charge customers?
$
What is your standard hourly rate applicable to projects delivered through WMEP?
Do you have tiered rates?
Do you renegotiate or reset rates annually?
If you have a price list, please provide it
Insurance
Do you have professional liability insurance or the equivalent?
Please provide the name of your liability insurance company
When does your existing liability policy expire?
Area of Expertise
Hold down the shift key to make more than one selection.
List three industry codes your organization serves most often.
Please describe your organization, services and expertise.
Name three key business strengths that set you apart from your competition.
Qualifications
Please include any relevant and active memberships, certificates, licenses, awards and other notable distinctions. Please keep this description to fewer than 100 words.
References
Please list 3 references whom we may contact about project(s) for which you or your organization provided services in the past two years. Please list project(s) that are as similar as possible to those you anticipate working on with WMEP.
Reference 1
Contact Name
Company or organization name.
Briefly describe the project and results.
Reference 2
Contact Name
Company or organization name
Contact Title
Briefly describe the project and results
Reference 3
Company or organization name
Briefly describe the project and results
Additional Contacts
Please complete the fields below for your primary and secondary company contacts. If you have more than two contacts you would like to include, please note this in the field at the bottom of this section.
Contact 1
Primary Contact Information
Years of experience
Number of clients your've served in the past two years.
Contact 2
Years of Experience
Number of clients you've served in the past 2 years.
Materials
Please provide the following items if available: Brochures, resumes, company Mission-value-vision, price list if appropriate, standard statement of qualifications
Attach here
WMEP
How did you hear about WMEP?
If you selected "other", please describe
Certify
This information is for WMEP to evaluate service providers. WMEP will use best efforts to hold this information confidential. I certify all information provided to WMEP is a true and factual representation and I authorize WMEP personnel to contact references to verity these statements. I understand that any inaccurate information may result in disqualification from the partnership program.