Zimmer Supplier Diversity Program Questionnaire

(* indicates required fields)

Company Address and Contact Information
Company Name: *
Street: *
City: *
State: *
ZIP: *
Phone: *
Fax:
Contact: *
E-mail: *
Contact Title:
Web Site:
Business Ownership Classification
Company Status: *
NAICS Code:
DUNS Code:
Business Information
Business Type: *
Total Employees:
Principal Products or Services
*
Describe Your Quality Program
*
Certification Information
A) If your company is a HUBZone, Small Disadvantaged or Veteran-Owned Business, has your company been certified by the Small Business Administration? If so, please enter your SBA Certification Number.
SBA Certification Number:
Date (MM/DD/YYYY):
B) Has your company registered on the Central Contractor Registration (CCR) Web site? *
If you answered No, please register at www.ccr.gov.
Zimmer cannot and will not promise to transact business with all suppliers who register with us. Resgistration does not in any manner guarantee registrants that their company will be identified, contacted, evaluated or selected to enter any business relationship with Zimmer.