* 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
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Washington DC
Fed States-Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
N. Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
* 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
US
Non-US
Year Business Established
* Last Fiscal Year Sales
-- None/Not applicable --
Under $100,000
$100,000 to $250,000
$250,000 to $500,000
$500,000 to $1 million
$1 million to $5 million
$5 million to $10 million
Over $10 million
Where are your branch locations? format: City/State (up to 60 chars)
Plant/Warehouse Size (square feet)
-- None/Not applicable --
Less than 10,000
10,000 to 25,000
25,000 to 50,000
50,000 to 100,000
Over 100,000
* Number of Employees
Less than 5
Between 5 and 10
Between 11 and 20
Between 21 and 50
Between 51 and 75
Between 76 and 100
Between 101 and 200
Between 201 and 500
Over 500
* 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?
Broker
Construction
Dealer
Distributor
Manufacturer
Service
Please select up to three commodity specialties for your organization
* The first column is REQUIRED
Acquired Products & Digital Media
Advertising
Assemblies
Benefits
Capital Equipment & Services
Chemicals
Circuit Boards
Construction
Contract Labor
Electrical Components
Facilities
Fuels & Energy
Gel & Bone
IT-3rd Party Software
IT-Desktop/Midrange
IT-Services
IT-Telecom
Logistics
Manufactured Services
Marketing Services
Metal Frames & Components
MRO & Spare Parts
Packaging Supplies
Plastics
Professional Services
Research & Development
Resins
Site Services
Systems & Software
Travel/Fleet
--OTHER--
-- None --
Acquired Products & Digital Media
Advertising
Assemblies
Benefits
Capital Equipment & Services
Chemicals
Circuit Boards
Construction
Contract Labor
Electrical Components
Facilities
Fuels & Energy
Gel & Bone
IT-3rd Party Software
IT-Desktop/Midrange
IT-Services
IT-Telecom
Logistics
Manufactured Services
Marketing Services
Metal Frames & Components
MRO & Spare Parts
Packaging Supplies
Plastics
Professional Services
Research & Development
Resins
Site Services
Systems & Software
Travel/Fleet
-- None --
Acquired Products & Digital Media
Advertising
Assemblies
Benefits
Capital Equipment & Services
Chemicals
Circuit Boards
Construction
Contract Labor
Electrical Components
Facilities
Fuels & Energy
Gel & Bone
IT-3rd Party Software
IT-Desktop/Midrange
IT-Services
IT-Telecom
Logistics
Manufactured Services
Marketing Services
Metal Frames & Components
MRO & Spare Parts
Packaging Supplies
Plastics
Professional Services
Research & Development
Resins
Site Services
Systems & Software
Travel/Fleet
* 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