*   = required
*Company Name:  
Address:  
City:  
State/Province:  
Postal Code:  
Country:  
*First Name:  
*Last Name:  
*Title:  
*Phone:  
Fax:  
*Email:  
Website URL:  
D&B Number:  
*Type of Business:  
Primary Products & Services:  
*Commodity Group:  
Geographic Locations (check all that apply):  
  Currently Served Able to Serve Facilities Located In
North America:
Europe:
Asia Pacific:
South America:
Total Annual Sales in U.S. Dollars:  
Number of Employees:  
Are you privately or publicly owned?  
Do you qualify as a Minority supplier?  
If YES, please explain:  
% of sales which are automotive:   %
Top three Customers:  
Customer Name % of Sales
%
%
%
What are your level of quality certification?  
Do you currently measure your own quality and delivery performance?  
Comments or Questions (Please be as specific as possible.)