JDSN - SDS - Create Supplier Profile

JDSN: Small Diverse Suppliers:

Monday, December 1, 2008 4:29:43 PM CST

Supplier Information
Company		Parent Company
Address		Phone
City		State	Zip
Web Address (URL)		Fax

Contact Information
Key Contact		Title
Phone		Fax
Email Address

Company Information
Type of Business		Number of Employees
Year Established		Company Category
Geographical Service Area		If regional or local, please specify
Product/Service Category 1
Product/Service Category 2
Product/Service Category 3
Product/Service Category 4
Products (Please describe any products you carry)	***Please attach any descriptive brochures and other pertinent information such as equipment used, etc.
Dun & Bradstreet Number		Federal ID or SSN

Annual Sales (Past 3 Years)
Year 1		Sales 1
Year 2		Sales 2
Year 3		Sales 3

Business Classification (Check all that apply) (Click Here for Description)
Small Business Woman-Owned Business Minority-Owned Business HUBZone U.S. Veteran U.S. Service Disabled Veteran Small Disadvantaged Business Handicapped	If you are a Minority Owned Business, please select a group below.

SDB Date of Certification	clear this date	8(a) Date of Certification	clear this date
*** A copy of your most recent 8(a) or SDB certification must be enclosed with this form.
Certified by Third Party	Yes No
If yes, provide the name(s) of the certifying organization(s)

Note For Minority or Woman-Owned Businesses, a copy of this certification must be returned with this form. This profile will be considered incomplete without the certification form.

Location and description of facilities
Type of Facility	Floor Space (sq. ft)	Address	Owned/Leased/Rented

List 3 Major Customers and Contacts
Company Name	Contact	Phone Number

Principal Owner(s) of Company
Name	Title	Phone	Email	% Ownership

NAICS Code and Description
SIC Code and Description
How Learned of Program
Are you EDI capable?	Yes No
Ever done business with John Deere?	Yes No

If Yes, Please Specify, Location/Name/Number
Location/Unit	Contact	Phone

This certifies that the information provided above and the company classification are true and accurate. I understand that it is my responsibility to notify John Deere if any of the above information changes.
Certified By		Title

***You no longer need to send in certifications or brochures

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