Data Sheet by callmemelo

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									                                          Data Sheet
1.   Corporation Name _________________________________________________________

2.   Mailing Address ___________________________________________________________

     ________________________________________________________________________

3.   Business address (if different from mailing address)

     ________________________________________________________________________

     ________________________________________________________________________

     ________________________________________________________________________

4.   Telephone _____________________________
                (Area code)

5.   Director's Name ______________________________ Telephone ___________________

6.   Name of contact person if other than Director ___________________________________

     ________________________________________________________________________

7.   List of names of those with authority to sign contracts (name/title/phone)

     ________________________________________________________________________

     ________________________________________________________________________

     ________________________________________________________________________

8.   Date of Incorporation _______________________________________________________

9.   Tax Status: The respondent should check one of the following:

     Profit _______     Private nonprofit __________

10. If the agency operates from more than one location, please provide the address and phone
    numbers of the other locations:

     ________________________________________________________________________

     ________________________________________________________________________

     ________________________________________________________________________

     ________________________________________________________________________

								
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