SUPPLIER PROFILE QUESTIONNAIRE
MMC CONFIDENTIAL
(PLEASE PRINT)
Fill out and Fax to 973.257.3330
Today's Date / /
Company Name __________________________________________________________________________________________________
Address ________________________________________________________________________________________________________
City ________________________________________ State __________________________ Zip ________________________________
Phone ______________________________________ Fax __________________________ www ________________________________
Company Contact _____________________________ Title __________________________ email _______________________________
Company Enclosed are complete business classification definitions as defined by the Small Business Administration. Please Classification
complete the following section based on those definitions. If you are unsure about your company's status, contact the
nearest U.S. Small Business Administration Office (SBA) for guidance.
____Large Business ____Small Business ____8(a) _____Foreign-Owned _____Non-Profit
NAICS Code North American Industrial Classification System if your business is classified as small, please list your U.S. SBA
Small Business Code(s). Please list no more than four in order of priority.
NAICS
Codes _________________, _____________________, ___________________, _____________________
Ownership Status A minority firm must be at least 51% owned, controlled, and operated on a daily basis by socially and economically
of Business disadvantaged individuals. A women-owned firm must be at least 51% owned by a woman or women who control and
operate the business on a daily basis.
____Women ____Minority Women ____Minority ____Non Minority ____Handicapped ____Veteran
Owned Owned Owned Owned Organization Owned
Citizenship Is the owner of the firm a U.S. Citizen? ___Yes ___No Official Residence of Owner:
Address: City: State:
Principal Officers If business is minority, minority-woman owned, or economically disadvantaged, it is mandatory that you complete the
following information for all principal officers of the company. Please indicate ethnicity as listed below, or specify
other.
BA Black American AP Asian Pacific American NA Native American (American Indian. Aleuts. , Eskimos, Hawaiians)
HA - Hispanic American SA Subcontinent Asian American NM - Non Minority
Name Ethnicity Ownership Male/Female
Chair
President
Vice President
Secretary
Treasurer
Other
Ethnic Institution Check if one of the following applies: Minority Institution Historically Black College or University
Business Structure ____Corporation ____(If Corporation, is it: ____Publicly Held? ____Privately Held?)
____Division ____Franchise ____Joint Venture ___Partnership _____Subsidiary _____Sole Proprietor
Parent
Company:
Type of Business ___Building/Grounds ___Carrier/Transportation ___Construction Contractor ____Contract Mfg ____Manufacturing
Number Order ___Dealer/Distributor ___Personnel/Staffing ___Professional Services ____Professional Administration Acct. Legal
of Priority ___Retail/Resale ___VAB/VAR(Value Added Business/Reseller) ____Other (Describe):
