Company Name*

Company Website

Contact Name

First Last

Phone*

Cell Phone

Fax Number

Email

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Ownership Classification

If you are not a certified minority business or a U.S. Citizen or your business is owned and operated outside of the United States, you are not eligible for the Supplier Diversity Program and your application will not receive a response.

Please indicate if your company is at least 51% owned and operated by one or more of the following groups. Please check all that apply.*

Non-Minority Woman
African American
Asian-Indian American
Disabled Veteran
Asian-Pacific Islander
Hispanic American
Native American

Certification Organization*

A minority or woman owned business MUST BE CERTIFIED through either the National Minority Supplier Development Council, the Women's Business Enterprise National Council or a similar Federal, State, or local governent minority certification program. Please indicate through which organization your company is certified.

Certification Number*

Please include your certification number.

Expiration Date*

Please include your certification expiration date.

Are you a U.S. Citizen?*

Yes
No

By marking "No" you signify that you do not qualify for this program.

Business Information

Please indicate your business structure*

(ie corporation, partnership, etc)

Federal Tax ID Number*

Year Established*

Number of Employees*

Please indicate your company's annual sales volume*

Please select applicable service area(s)*

Local
Regional
National (States)
International

What type(s) of item(s) or service(s) do you provide?*

What specific item(s) / service(s) are you submitting for proposal?*

With what other major companies do you currently do business?*

Are you currently doing business with Green Mountain?*

Yes
No

Have you previously done business with Green Mountain?*

Yes
No

Have you applied to Green Mountain's Supplier Diversity Program before?*

Yes
No

Supplier Diversity

Green Mountain Supplier Diversity Program

Business Ownership Classification

Business Information

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