Supplier Diversity: Your Company Profile

Your Company Profile
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Please note: This form in no way obligates Kodak nor guarantees business. It does, however, provide us with a clear understanding of your firm's capabilities and experience. We will contact you for bidding in the event that your company profile matches our requirements. The website confirmation of your company profile will be the only communication you will receive until we have a need to contact you for additional information.

To be considered as one of our suppliers, complete the online form below. This form will capture your business information into our prospective supplier database.

Click link for Purchasing Contact name/phone/e-mail: Purchasing Commodity Contact List

The information you provide may be shared with other companies who are engaged in a search for diverse suppliers.
Supplier Diversity - Company Profile Form
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* Required fields

* Is this a NEW or UPDATED application for your business? New      Updated  
* Contact Name
* Contact Title
* Email
* Company Name
* Street Address One
Street Address Two
* City
* State
* Zip Code
* Telephone Number
format: 123-456-7890
* Fax Number: same format as above
Owner/Officer Name
Owner/Officer Title
Dun and Bradstreet number:
NAICS Code
(6 digit number)
Second NAICS Code
Third NAICS Code
Citizenship of Owner/Officer
Year Business Established
* Last Fiscal Year Sales
Where are your branch locations? format: City/State (up to 60 chars)
Plant/Warehouse Size (square feet)
* Number of Employees
*Are you Third Party certified? yes      no  
If yes, enter Third Party Certifier name?
Certification Expiration Date: (mm/dd/yyyy)
* Ownership categories (check all that apply)
Select One: large      small  
Minority-owned Business        Women-owned Business       
Disabled Veteran Business Enterprise        Veteran-owned      
Sheltered workshop        Small Disabled Business
HUB Zone        LGBTBE  
* Ethnic group of owner/officer (select one)
Asian Pacific Islander        African American        Hispanic       
Native American        Asian Indian       
Is your business a subsidiary of another company? yes      no  

If YES, Name of company
Is your business a division of another company? yes      no  

If YES, Name of Company
Is your business franchised by another company? yes      no  

If YES, Name of Company
* Are you currently a Kodak Supplier? yes      no  

If YES, please list your Vendor Number
Please list three customer references:
At least one is required		 * Firm/Contact/Phone

Firm/Contact/Phone

Firm/Contact/Phone
Banking Reference Financial Institution/Phone
Does your company have a Quality Control Program? yes      no  
* What type of business are you?

Please select up to three commodity specialties for your organization

* The first column is REQUIRED

* Please enter keywords describing your business specialty (up to 200 chars total)
Keywords must be separated by a comma (,)

Service Capability (check all that apply)

local       regional       national       international