Technical Assistance: Individual Assistance Request Form

Please fill in the following Individual Assistance Request Form and click the Submit button to send.

If you do not receive confirmation within two business days that your request has been received, please contact Sharon Evans at 505-845-9671.

An asterisk (*) indicates a required field.

Company Name *

First Name *

Last Name *

Title

Phone *

Fax

Address

City

County

State

Zip/Postal Code

My company is located in New Mexico
Yes No

My company is a small business
(Per U.S. Small Business Administration guidelines)
Yes No

My company is a for-profit business
Yes No

My business pays gross receipts taxes to the State of New Mexico
Yes No

My company is U.S. owned and operated
(Not foreign owned or controlled)
Yes No

Is your company a subsidiary?
Yes No

Describe the type of assistance needed *:

Do you have a laboratory preference for this assistance request?
No Preference
LANL
SNL

If you know of a laboratory employee who might be able to assist you with this request, please provide this person's name:

How did you hear about the NMSBA program?

If you do not receive confirmation within 2 business days that your request has been received, please contact Sharon Evans at 505-845-9671.