DISA JITC

CTE-1 Form * = Required

Updated: 7/25/2023 9:18:17 AM

COMPLIANCE TEST REQUEST

Test Campaign Number (Optional - assigned by JITC)

Date Received

*RMA Product Name (Baseline Product)

RMA Product GSA Number (Optional)

*Date RMA Available for Sale

*RMA Developer

INFORMATION REQUIRED FOR CONTRACT

*Test Sponsor's Legal Corporate Name

*Test Sponsor's State of Incorporation

IRS Tax Yr. (optional - mm/yyyy)

*Test Sponsor's DUNS Number

System Award Management (SAM) Expiration Date (Optional)

*Test sponsor has coordinated rights to assign licenses with: (List Rights Owners, including RMA Developer)

*Parent Company Name

*Parent Company Address

*Parent Company Country of Incorporation

*Statement of Ownership

*One Brief Paragraph on Corporate History (No Sales Talk)

CONTRACT FORMAL NOTICES POINT OF CONTACT

*Contact

*Company Name

*Street Address

*City

*State

*Zip Code

Phone Number

Fax Number (Optional)

*E-mail Address

AGREEMENTS/CONTRACTS POINT OF CONTACT
(Optional: If this Contact is blank, the Contract Formal Notices POC will be the POC for Agreements/Contracts)

Contact

Company Name

Street Address

City

State

Zip Code

Phone Number

Fax Number (Optional)

E-mail Address

LEGAL POINT OF CONTACT
(Optional: If this Contact is blank, the Agreements/Contracts POC or Contract Formal Notices POC will be the POC for Legal actions)

Contact

Company Name

Street Address

City

State

Zip Code

Phone Number

Fax Number (Optional)

E-mail Address

CONTRACT TECHNICAL POINT OF CONTACT

*Contact

*Company Name

*Street Address

*City

*State

*Zip Code

*Phone Number

Fax Number (Optional)

*E-mail Address

CONTRACT FINANCIAL COORDINATION POINT OF CONTACT

*Contact

*Company Name

*Street Address

*City

*State

*Zip Code

*Phone Number

Fax Number (Optional)

*E-mail Address

SIGNATURE BLOCK OF PERSON WHO CAN LEGALLY BIND THE CORPORATION

*Company Representative Name

*Company Representative Title

POINTS OF CONTACT FOR TEST COORDINATION

*Primary Point of Contact

*Phone Number

*E-mail Address

Alternate Point of Contact (Optional)

Phone Number (Optional)

E-mail Address (Optional)

Verification

Verification Image (Click To Change)

Enter Image Text (Required - Case Sensitive)

Save and Acknowledge

By submitting this COMPLIANCE TEST REQUEST I cerify that all the above information is correct...

JITC

JOINT INTEROPERABILITY TEST COMMAND