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POTENTIAL VENDOR PROFILE

BUSINESS ADDRESS
Company Name:
Address:
 
City:
State:  
Zip:  
Phone:  
Fax:  
E-Mail: 
Website:
   
BUSINESS INFORMATION
Business Entity Type:
Business Tax ID:
Tax Type:
Year Established:  
No. of Employees:  
No. of Minority &
Female Employees:
 
Annual Sales ($):  
 
Principal Owner(s) of Company:
Name   % Ownership  Ethnicity  Gender   Disabled
Name   % Ownership  Ethnicity  Gender   Disabled
Name   % Ownership  Ethnicity  Gender   Disabled
   
CONTACT INFORMATION
Contact Name:
Title:
Address:
 
City:
State:  
Zip:  
Phone:
Fax:
E-Mail:
   
DESCRIPTION OF YOUR PRODUCT(S) OR SERVICE(S)
   
CLIENT REFERENCES
Company Name:     Contact:     Phone:   
Company Name:     Contact:     Phone:   
Company Name:     Contact:     Phone:   
 
MBE/WBE/DBE CERTIFICATION
To insure that only bona fide MBE/WBE/DBE participate in the Calumet Diversified Meats Supplier Diversity Program, we require certification from a recognized U.S. certifying agency.

Please submit a copy of your current certification document or application. CERTIFICATION DOCUMENT MUST BE RECEIVED WITHIN 90 DAYS OF SUBMISSION OF POTENTIAL VENDOR PROFILE. You may submit your certification electronically to info@porkchops.com or by fax to (262) 947-7209.

   
ACKNOWLEDGEMENT
Please initial in the box below acknowledging that you are a company official and that all information is correct. Be advised that any false representation of your company as a minority, woman or disadvantaged-owned business will result in immediate disqualification from Calumet Diversified Meats Supplier Diversity Program.
   
Initials:  
Name:  
Title:  
Date:  

 

 

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