Supplier Profile Questionaire
 
Supplier Profile FAQ's
* indicates required fields
** indicates one or the other field must be completed
Company Information  
*Full Legal Name of the Company:
*Company Address:
*City:
*State
or Province:
*Country:
*Zip/Postal Code:
Company Web Address:
*Contact Person:
*Title:
*Telephone Number:
Fax Number:
*Email Address:
 
Parent or Subsidiary Information (if different from Supplier)
Parent or Subsidiary Full Legal Name:
Address:
City:
State
or Province:
Country:
Zip/Postal Code:
 
Company Profile
**Primary NAICS Code:
Secondary NAICS Code:
Stock Exchange Symbol (if Publicly Traded):
**Primary SIC Code:
Secondary SIC Code:
*DUNS Number:
Parent DUNS Number:
 
Company Category (*Select All that Apply):
Individual
Corporation
Proprietorship
Franchise
Partnership
Joint Venture
 
Business Type (*Select All that Apply):
Broker
Manufacturer
Manufacturer's Representative
Service
Distributor
Construction
Consultant
Wholesale
Packaging Supplier
Ingredient Supplier
Grower
Other - Please Specify:
 
Company Profile (*Select All that Apply):
Large Business Enterprise (Revenues > $5 Million)
Medium Business Enterprise (Revenues > $1.5 Million but < $5 Million)
Small Business Enterprise (Revenues < $1.5 Million)
Government or Non Profit
Foreign-Owned Business Enterprise
Minority Institution (College or University)
Other - Please Specify:
 
If you are a Diversity Supplier, please complete the following.
 
Diversity Status (Select All that Apply):
Asian-Indian
Asian-Pacific
Black
Hispanic
Native American
Women-Owned Business
Veteran-Owned Business
Minority-Owned Business
Service-Disabled-Veteran-Owned Business
Disadvantaged Business
HUBZone Business
Diversity Links
 
Company History and Certification
Year Established:
Number of Employees:
Product/Service Description:
Total Sales/Revenues for Last Three Years
Year 1: $
Year 2: $
Year 3: $
 
Diversity Certification Agency Certification Number Expiration Date
1.  Click here to select an Expiration Date 
2.  Click here to select an Expiration Date 
3.  Click here to select an Expiration Date 
4.  Click here to select an Expiration Date 
5.  Click here to select an Expiration Date 
 
Geographical Service Area (Select All that Apply):
Local - Ability to service Gallo locations from up to a 100 mile radius of supplier location(s)
Regional - Ability to service Gallo locations from up to a 250 mile radius of supplier location(s)
National
International
If Local or Regional, please specify Service Area: