Supplier Diversity Questionnaire and Contact Information

* Required Information


Company Name *  
 
Contact Name *  
 
Street Address *  
 
City *  
 
State *  
Zip Code *  
 
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


Acknowledgement of Consent

Any Personal Data collected on this Supplier Registration Form is processed in accordance with our Privacy Statement for the purposes of registering a supplier to CommScope.