Darden Restaurants - Existing Supplier Diversity Disclosure Form

Existing Supplier Diversity Disclosure Form

* denotes a required form field

This form should ONLY be filled out if your company qualifies as a certified Minority Business Enterprise (MBE) and/or Women Business Enterprise (WBE). All other vendors: please contact us at (407) 245-4000.


Business Information:

Business Name:*

Vendor Number:*		Supplier Number:*

Federal ID Number:*		SIC Number:* (SIC number found on your operational license)



Owner Title: First Name:*		Owner Last Name:*

Contact Title: First Name:*		Contact Last Name:*

Address Line 1:*		Address Line 2:

Address City: * Address State:* Address Zip: *

Telephone:* Ext Fax #: Mobile #:

Email Address: *		Web Site Address:

Business Type:*		Date Established: *	(MM/DD/YYYY)

Geographic Service Area:*		Service Area Type:

Number of Employees:*		Number of Minority Employees:*

Product/Services:*		Annual Sales: * (no comas or dollar signs)	$


Darden Information:

Vendor Type:

Small Business:*	Yes No	Woman Owned: * Yes No

Minority Owned: *	Yes No	Ethnicity: ( * required if Minority Owned)

Certified: ( * required if Woman or Minority Owned)	Yes No	By which entity: ( * required if Woman or Minority Owned)

Certification Date: ( * required if Woman or Minority Owned)	(MM/DD/YYYY)	Certification Expire Date: ( * required if Woman or Minority Owned)	(MM/DD/YYYY)

Member NMSDC:* www.nmsdc.org	Yes No	Member WBENC:* www.wbenc.org	Yes No

Category:*		Sub-Category:*