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Supplier Diversity Program
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Questionnaire: Potential New Supplier

Your Contact Information
Name: *
Title:
Company Name: *
Address:
City, State, Zip:
Phone: *
Email: *
Website:
 

* - Required Field
Your Company
   
1) Please describe the products/services you are interested in providing to United Stationers or one of our companies.
 
2) What is the nature of your role?
Manufacturer
Please Specify: Products for re-sale Products for use internally at United Stationers
Distributor
Please Specify: Products for re-sale Products for use internally at United Stationers
Service Provider
Please specify service(s):
 
3) How would you describe your company?
Public corporation
Please indicate stock trading symbol/ticker
Limited liability company (LLC)
Joint venture
Partnership
Sole proprietor
Non-profit
Other
Please specify:
 
4) Primary SIC Code?
Please specify Primary SIC Code:
 
5) What is you Geographical service area?
National
Please specify:
Regional
Please specify:
Local
Please specify:
 
6) Is your business categorized as one of the following?
Minority Business Enterprise (MBE)
Please specify type:
Women Business Enterprise (WBE)
Disabled Person Business Enterprise (DPBE)
Service Disabled Veteran Enterprise (DVE)
Small Business (HUB, SDB)
Other
If Other, please describe:
 
7) From what organizations/agencies have you received certification or are in the process of applying for?
NMSDC (National Minority Supplier Development Council)
  Certification Date:
WBENC (Women's Business Enterprise National Council)
  Certification Date:
SBA (Small Business Administration)
  Certification Date:
City of: Certification :
  Certification Date:
State of: Certification :
  Certification Date:
County of: Certification :
  Certification Date:
Other (Please Describe)
  Certification Date:
   
8) What is your company's estimated size (sales in U.S. currency, number of employees, etc.)?
   
9) Does your company have a sustainability or "green" initiative?  Please describe activities, including manufacturing operations, and impacts on products (such as recycled content) and packaging if any.
   
10) Please provide any additional information that you would like us to consider
Your Suppliers - the people you do business with
 
1) Do you have a supplier diversity program?
Yes No In the process of implementing
 
2) If so, what components have you implemented?
training for those responsible for sourcing and purchasing
establishment of a database of suppliers by product/service category
tracking mechanism
established spending goals for diverse suppliers
outreach to diverse suppliers
partnership with third party certification organizations
training and/or mentoring for diverse suppliers
tracking second tier spending (i.e., efforts from your suppliers)
Other
Please specify:
N/A
 
3) With what groups do you track your level of spend?
Minority Business Enterprise (MBE)
Please specify type:
Women Business Enterprise (WBE)
Disabled Person Business Enterprise (DPBE)
Service Disabled Veteran Enterprise (DVE)
Small Business (HUB, SDB)
Other
Please describe:
 
4) What are your spending goals for diverse suppliers?
 $
  % of total spend in (year)
N/A
 
5) What was your actual spend with the supplier groups above (both suppliers of goods and professional services)?
 $
  % of total spend in (year)
N/A
 
6) Have you established other components of a diversity program within your organization? (e.g., related to the workforce, community, or customers)?
 
Yes No
If Yes, Please describe: