INSTRUCTIONS: Please fill out all relevant information to assist us in our search for the supplies/services you seek. The more information you provide will result in a more efficient and complete search. All information submitted is confidential. NOTE: As a condition of engaging in CIRAS Supplier Scouting, companies agree to provide feedback to CIRAS on the success of the scouting efforts.Company Name(Required)Location(Required) City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific County(Required)AdairAdamsAllamakeeAppanooseAudubonBentonBlack HawkBooneBremerBuchananBuena VistaButlerCalhounCarrollCassCedarCerro GordoCherokeeChickasawClarkeClayClaytonClintonCrawfordDallasDavisDecaturDelawareDes MoinesDickinsonDubuqueEmmetFayetteFloydFranklinFremontGreeneGrundyGuthrieHamiltonHancockHardinHarrisonHenryHowardHumboldtIdaIowaJacksonJasperJeffersonJohnsonJonesKeokukKossuthLeeLinnLouisaLucasLyonMadisonMahaskaMarionMarshallMillsMitchellMononaMonroeMontgomeryMuscatineO'BrienOsceolaPagePalo AltoPlymouthPocahontasPolkPottawattamiePoweshiekRinggoldSacScottShelbySiouxStoryTamaTaylorUnionVan BurenWapelloWarrenWashingtonWayneWebsterWinnebagoWinneshiekWoodburyWorthWrightName(Required) First Last Title(Required)Email(Required) Phone(Required)Requested Scouting Location(Required)StatewideSurrounding States / RegionalNationwideName of Item Being Sought(Required)Item Description(Required)Application(Required)(How the item is used)Materials and Manufacturing Process used (if known)Summary of Technical and Performance Specifications(Required)Volume Estimate(Required)(Quantity and Frequency)Target PriceDelivery Date RequirementsQuality/Certification Requirements(Required)Current Suppliers of Good/Service(This eliminates duplication of effort in identifying sources already in use.)Additional Comments / Summary of Previous Research(Required)Please provide a summary of the research you have conducted. This provides context on where we should begin our research to avoid duplication of effort. We want this information to be value-add for your company.Potential Impact(Required)Please consider what the business impact is in identifying a new/alternate source. For example, will it reduce production line shutdowns/delays; will it help generate new business growth, etc.CAPTCHANameThis field is for validation purposes and should be left unchanged.