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Supplier Verification Form

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Required fields are bold.

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Section I. Business Information

Company Information
Legal Company Name:
User Name:
Doing Business As:
Federal Tax ID Number:
D&B DUNS Number:
 
Physical Address
Physical Address:
Address (Cont.):
City:
Country:
State:
Zip/Postal Code:
 
Remit To Address
Remittance Address:
Address (Cont.):
City:
Country:
State:
Zip/Postal Code:
 
Company Phone Number:
Company Fax Number:
Company Website (URL):
 

Contact's Information
Contact Name:
Job Title:
Phone Number:
 Ext.
Fax Number:
E-Mail Address:
 
Please select the Nestlé Groups that you are currently doing business with.

Will the contact at your company differ for this group from the contact information listed in the "Contact's Information" section?
Dreyers Group Contract Contact Information
Contact Name:
Job Title:
Phone Number:
 Ext.
Fax Number:
E-Mail Address:
What services are you currently providing to this Nestlé Group?
What services would you like to provide in the future?
 

Will the contact at your company differ for this group from the contact information listed in the "Contact's Information" section?
Nestle Nutrition (Novartis, Gerber, Jenny Craig, PowerBar) Group Contract Contact Information
Contact Name:
Job Title:
Phone Number:
 Ext.
Fax Number:
E-Mail Address:
What services are you currently providing to this Nestlé Group?
What services would you like to provide in the future?
 

Will the contact at your company differ for this group from the contact information listed in the "Contact's Information" section?
Nestlé Purina PetCare Group Contract Contact Information
Contact Name:
Job Title:
Phone Number:
 Ext.
Fax Number:
E-Mail Address:
What services are you currently providing to this Nestlé Group?
What services would you like to provide in the future?
 

Will the contact at your company differ for this group from the contact information listed in the "Contact's Information" section?
Nestlé USA Group Contract Contact Information
Contact Name:
Job Title:
Phone Number:
 Ext.
Fax Number:
E-Mail Address:
What services are you currently providing to this Nestlé Group?
What services would you like to provide in the future?
 

Will the contact at your company differ for this group from the contact information listed in the "Contact's Information" section?
Nestlé Waters Group Contract Contact Information
Contact Name:
Job Title:
Phone Number:
 Ext.
Fax Number:
E-Mail Address:
What services are you currently providing to this Nestlé Group?
What services would you like to provide in the future?
 
 

Section II. Business Biography

Company Data
 
Geographical Service Area (What is this?):


Year Business Established:
Number of Employees:
Number of Years Supplying to Nestlé:
 
Where did you meet us?
 
Company Ownership:
 

Products and/or Services
(What is NAICS?)
Select Primary NAICS Code  
 
 
Please click here to select Secondary NAICS Codes.  
 
To remove items from the list above, highlight the commodity code and click the 'Remove From List' button.
 
(What is this?)
Select Nestlé Categories / Commodity Codes.  
 
To remove items from the list above, highlight the commodity code and click the 'Remove From List' button.
 
Primary SIC Code:
 
Enter specific keywords describing your food service, packaging,
or ingredients experience(up to 500 characters).
 

Annual Sales Volume

(Quoted in US dollars, numbers only, no comma or decimal point. I.E., 3000000)
2008
2007
2006
 

References
List up to three customers: (at least one reference is required)
Reference 1
Company Name Contact Name Phone Number
Product/Service Provided Largest Contract to Date  
 
Reference 2
Company Name Contact Name Phone Number
Product/Service Provided Largest Contract to Date  
 
Reference 3
Company Name Contact Name Phone Number
Product/Service Provided Largest Contract to Date  
 
 
 

Certification Information
If your company is a minority-owned, woman-owned or small business enterprise, please check the appropriate box(es) below and follow the prompts.
 
NOTE: Uploaded documents size limit is 1MB. Anything larger will not be accepted and result in unsuccessful submission.
 
NOTE: If it is automatically determined that you are recognized as a Small Business Enterprise and are not currently certified by any third party agency as any of the classifications listed below, you will be prompted and required to complete a Self Classification Form on the next page.
 

A small business is a concern that, including affiliates, is independently owned and operated, is not dominant in its field of operation, and meets the appropriate size standards established by the SBA. Size thresholds for different industries, measured either according to the number of employees of a concern or its annual receipts are set forth in various North American Industrial Classification System codes. A breakdown of the NAICS codes and applicable thresholds may be found on the Internet at http://www.census.gov/epcd/naics/naics3dx.htm and http://www.sba.gov/size/indexsize.html

A business that is at least 51% owned by one or more minority US citizens. In the case of a publicly owned business, at least 51% of the stock must be owned by one or more such individuals, and its management and daily operations must be controlled by one or more such individuals.

A business that is at least 51% owned by a woman or women who exercise the power to make policy decisions and who are actively involved in the day to day management of the business.
 

False Representation of Business Statement

 
I certify all information provided in this form is true and accurate. I understand the submittal of this form does not guarantee business with Nestle or its affiliated divisions.
 
Preparer's Name:
Preparer's Phone Number: Ext.
Preparer's Email Address:
 
You are almost done! Select whether you agree to the false representation statement above and then click the submit button below. If the Self Certification form is applicable for your company it will be available for download on the next page.