Supplier Diversity Questionnaire and Contact Information

  * Required Information
Company Name *
  
Contact Name *
  
Street Address *
  
City *
  
State *
  
Zip *
  
Telephone *
  
Fax
Email *
  
Website

Business Ownership Classification

Company Type *
 
Ethnicity *  
NAICS Code *
  
DUNS Code *
  
Business Type *
 
Annual Sales
(Currency:USD)
Service Area *

 
Year Established *
  
Structure
Parent Company
Incorporation


State of Incorporation
Total Employees (25000)

Products and Services That You Offer

Principle Product*
 
Other Products and Services

Quality Status/Certification

ISO 9000

QS 9000

TL9000

Other

Not Applicable

Certification Information

Is your company certified? *


If yes, please answer the following questions.
A) Has your company been certified by any regional NMSDC purchasing council? If so, please list.
Council
Number
Date (MM/DD/YYYY)
B) Has your company been certified by the Small Business Administration? If so, please list.
SBA Certification Number
Date (MM/DD/YYYY)
C) Other agencies that have certified your firm as a minority, women, or disadvantaged business enterprise.
Agency
Number
Date (MM/DD/YYYY)

Key Customers That You Do Regular Business With

Company Name
Contact
Telephone
Company Name
Contact
Telephone
Company Name
Contact
Telephone

Comments

Are you currently a supplier to CommScope?



If yes, please provide vendor code:

Do you have electronic capabilities?

Email
Reverse Auctions
Other