PSC Home Page
What We Offer

Supplier Diversity Application


Untitled Page
Required fields are marked with a red (*).
General Information

Company Name:*
 

Company Address:*
Line 1  
Line 2

City:*
State: *
Zip: *

 		  
   

Website Address: *
 

Contact Name:*
Job Title:*
   

Phone: (xxx-xxx-xxxx)*
Fax: (xxx-xxx-xxxx)*
       

E-mail:*

  
Products and Services

Please describe the products and/or services you offer.*
 

Are you currently providing this product/service?*
 

Please list the geographic areas you can serve.*
 
Company Information
Legal Company Name: * Percentage Ownership: *

 
 
Legal Structure:* Specify Other:

 

Year Established:* Number of Employees:*

 
 
Dun & Bradstreet Number:* Tax ID:*

 
 

Standard Industrial Codes (SIC) or North American Industry Classification System (NAICS) Codes:*

 
Diversity Information
% of Minority Ownership:* Business Type:*

 
 

Please select the applicable category:* For further information and definitions, please reference the following links: National Minority Supplier Development Council. or Women's Business Enterprize National Council.
 
 
Yes / No
Are you a US Citizen?*
 

If you are a small business, do you have any of the following certifications? Please refer to the links (??) following each certifications for further information:
  Yes / No
Small Disadvantaged Business*(??)
 
HUBZone*(??)
 
Service-disabled veteran owned small business*(??)
 

Please provide your certification information.

Certifying organization: *
 

Certification #: *		 Expiration date: *
   



If you have any questions on our policy on supplier diversity, please email us.
About PSC

Our Management Team

Locations

Join the PSC Team

Contact Us

Strategic Sourcing

Policy on Supplier Diversity

Our Values