Please complete/verify all information. An MRC representative will respond within a few days.

Fields marked with an asterisk (*) denote a required field. Required fields must be filled out in order for entry to be processed.

* Company Name:
* NAICS:
* Company Contact:
Title:
* Email Address:
* Phone: xxx-xxx-xxxx
Fax: xxx-xxx-xxxx
Street Address
* Address:
* City:
* State:
* Zip Code:
Mailing Address Same as Street Address
 
Address:
City:
State:
Zip Code:
* County:
* Municipality:
* Number of Employees: This facility: All facilities:
* Federal ID#:
* Annual Sales:
* PA Sales:
* Export Sales:
* Workforce Devl.
% of Sales:
* R&D % of Sales:
How Did You Gain Knowledge of MRC?
Advertising Chamber of Commerce Customer Referred
Econ. Devl. Agency Other IRC Repeat Cust.
Annual Report College/Univ. Direct Contact
Mfg. Assoc. PENNTAP Seminar/Network
Ben Franklin COMPETE! Direct Mail
Media Story Professional Serv. Web Site
BQP Consultant East. PA Bus. Journal
Other:
Description of Assistance Needed:
Goals For This Assistance: 1.
2.
3.
 

The above referenced company requests assistance from the Manufacturers Resource Center (MRC). We understand that we can choose a service provider from MRCÌs pool of available resources. We understand that the service provider, the MRC staff and MRC Board of Directors will treat all confidential and proprietary information in complete confidence, and the service provider will advise us of any potential conflicts of interest that he may have because of engagement with other clients. We authorize MRC to release our companyÌs identity and summary information of a generic nature describing the engagement to the MRCÌs funding agencies. We agree to honor any reasonable requests for information concerning our company as needed during the engagement.

We understand that the service to be provided by MRC shall be in the nature of management consulting, advice, information, and technology assistance, and we understand, acknowledge and agree that at no time will MRC or the MRC service provider control or accept or undertake the ability to control the actions, functions, or operations of our company or any part thereof, but our Company will at all times remain in full control of and responsible for its own actions, functions, and operations. The information, opinions and recommendations presented by the MRC service provider are based upon the information available to the service provider and to MRC, but the services of MRC are not warranted or guaranteed in any way. In consideration of this assistance, we hereby waive any right which we may have to any and all claims arising from the assistance provided hereunder against the service provider, MRC, the Board of Directors of MRC, Lehigh University, the Trustees of Lehigh University, the Commonwealth of Pennsylvania, NIST, and any other persons or entities whatsoever, including any and all claims arising from their negligence, errors, or omissions. We further understand and agree that the work product of the service provider (including without limitation all advice, opinions, recommendations, information, reports, calculations, technical data, and evaluations) are for the exclusive use of our company and MRC only, and we agree not to disclose any of the service providerÌs work product to any third party whatsoever, including without limitation any actual or potential purchaser, investor, lender, customer, supplier, landlord, or tenant of our company, or to any financial institution or governmental entity, without MRCÌs advance written permission. In the event we violate our obligation not to disclose the service providerÌs work product to any third party, we agree to indemnify MRC and the service provider from any liability arising therefrom. The signature below by any authorized company representative verifies that we accept these terms and conditions and that the information presented on this Request for Assistance is accurate as of the date signed.