https://www.bloombergindustry.com Supplier Registration & Supplier Diversity Form
Supplier Registration & Supplier Diversity Form
 


 

Basic Contact Information


In accordance with U.S. Government regulations, we are required to verify the size and classification of our suppliers on a regular basis. Bloomberg Industry Group is committed to fostering the economic growth within the minority business community and encourages companies to obtain third party certification as a small, minority, disadvantaged or HubZone business. To aid us in validating/maintaining current supplier data records, please complete all required fields.

 

Business Information

BUSINESS TYPE

CHECK ALL THAT APPLY

 Corporation  Individual / Sole Proprieter  Joint Venture
 Large Business  Partnership  Small Business
 Other

BUSINESS OWNERSHIP/CLASSIFICATION

CHECK ALL THAT APPLY

 African American  Alaska Native Corporation  Asian Indian American
 Asian Pacific American  Disability-Owned Business Enterprise  Disabled Veteran-Owned
 HBCU/MI  Hispanic American  HUBZone
 LGBTQ+  Minority Owned  Native Hawaiian
 Service Disabled Veteran-Owned  Small Disadvantaged Business  Veteran-Owned
 Woman-Owned  Other

Which of the following best describes the type of industry your company or organization is in?

 Advertising, Media Planning or Public Relations  Business Services  Catering
 Consulting  Consumer Goods  Electrical Equipment
 Facilities  Health/Healthcare Services  Lodging & Hospitality
 Marketing  Media  Software, IT Services, Data Services
 Tech hardware and Semiconductors  Telecommunications  Transportation
 Other

HAS YOUR COMPANY BEEN CERTIFIED BY A THIRD PARTY ORGANIZATION?

 Yes        No

Is your company listed in a small business directory (for verification purposes)?

 Yes        No

 

Penalties for Misrepresentation of Size Status: Section 16(d) of the Small Business Act, as amended, prohibits the misrepresentation of size status in connection with procurement programs. Severe criminal penalties will be imposed for knowingly making statements or misrepresentation of size status, including, but not limited to fines, suspension, and debarments.