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Supplier Profile

In an effort to become more familiar with our existing supplier base, Atmos Energy requests that this form be completed at your earliest convenience. Your company's questionnaire will remain confidential and be kept on file to better manage our relationship with your company. An electronic signature can be added in this web form by an authorized representative of the company.
The form can be submitted via the "Submit" button below once completed.

* = Required

Payment Address 2:
County:
Owner Title:
  
First Name            Last Name
Company Primary Contact Title:
 - 
Fax: - 
DUNS #:
Business Primary NAICS1 code:
1NAICS codes are needed for the Summary Subcontract Report breakout report (by 3-digit NAICS subsector) that the Prime Contractor is required to submit to the Government annually pursuant to the Federal Acquisition Regulation("FAR") clause at 52.219-9(1)(2)(iii). NAICS codes for business may be found at www.sba.gov/size.
Large Business  Small Business  Charity or Non-Profit
Government Entity  Civic or Trade Association
If you are a large Business, do you operate a Supplier Diversity or Small Business Program? Yes  No
Please indicate if your company is at least 51% owned and operated by an individual in one or more of the following categories:
 Woman Owned  Veteran Owned  Service Disabled Veteran Owned 
 Small Disadvantage Business  HUBZone (Federal designee only) 


The undersigned acknowledges under penalty per 15 U.S.C. 645(d), that the information provided herein is current and accurate. Any person who misrepresented its size status shall (1) be punished by a fine, or both; (2) be subject to administrative remedies; and (3) be inelegible for participation in programs conducted under the authority of the Small Business Act.


Authorized Signature*


  *I accept the terms and conditions and authorize the signature


Small Business Size Classifications: For size clarification you may wish to review the definitions for the above categories in the Federal Acquisitions Regulation (“FAR”) 19.7 or 52.219-8. If you have difficulty ascertaining your size status, please refer to the SBA’s website at www.sba.gov/size or contact your local SBA office.