Please print, complete, and fax this form to (732) 335-2244. 
or send to
Supplier Diversity Coordinator/Purchasing
600 Highway 36
Hazlet, NJ 07730

For questions, email us at supplier.diversity@iff.com.

Company Address and Contact Information
Company Name:
Street:
City:
State/Province:
Postal Code:
Phone:
Fax:
Contact:
Email:
Contact Title:
Website:

Years in Business:

Service Area:

   International    National    Regional      Local         

Business Ownership Classification
Company Status:
Citizenship:
 U.S. Citizen Non-U.S. Citizen
Gender:
 Male-Owned Business Female-Owned Business
Ethnicity:
    
Disabled/Veteran:
    

Principal Products or Services:

 

Certification Information - (please include a copy of any certification)
A. Has your company been certified by any regional NMSDC purchasing council? If so, please list.
Council:
Number:
Date:
B. Has your company been certified by the Small Business Administration. If so, please list.
Certification #:
    
Date:
C. Other agencies that have certified your firm as a minority, woman, or disadvantaged business enterprise:
Agency:
Number:
Date:

Major Customers That You Do Business With:
Customer:
Contact:
Phone:
Customer:
Contact:
Phone:
Customer:
Contact:
Phone:

In the future, if requested, do you have the capability of identifying spending with the following business types?
Small Business:
 Yes No
Women Business Entrepreneur:
 Yes No
Minority Business Entrepreneur:
 Yes No
Disabled/Veteran:
 Yes No

Please feel free to forward any brochures or marketing material when returning the completed form.

Comments: