Supplier Profile
Fields marked with an * are required.

Company Information
Company Name:*
Company Type:*
Which of the following best describes your company?*

Street Address:*
State:* Postal Code:*
Telephone Number:* Fax Number:*
E-mail Address:*
Web Site Address:
Contact Name:*
Federal Tax ID #: Example: 12-1234567
Dun & Bradstreet #: Example: 12-123-1234

Business Ownership
(Check all that apply.)

Business Classification
(Check all that apply.)

List of Products and/or Services*

Additional Company Information

Standard Industry Code(s) (SIC):*  
Is your company EDI ready?*
Is your company credit card (payment) ready?*
Has your business been certified by a third party organization?*
If so, which organization? (Check all that apply.)

National Minority Supplier Development Council (NMSDC) or its affiliate
Certification No.: 
Exp. Date (MM/DD/YYYY): 

Women's Business Enterprise National Council (WBENC) or its affiliate
Certification No.: 
Exp. Date (MM/DD/YYYY): 

Small Business Administration or its approved certification organization
Certification No.: 
Exp. Date (MM/DD/YYYY): 

State Government
Certification No.: 
Exp. Date (MM/DD/YYYY): 

Municipal Government
Certification No.: 
Exp. Date (MM/DD/YYYY): 

Local Purchasing Councils
Certification No.: 
Exp. Date (MM/DD/YYYY): 

Self Certification
Certification No.: 
Exp. Date (MM/DD/YYYY): 


When contract mandates, can your company provide the following safety and insurance information?
Does your company have a safety program?*
OSHA Total Recordable Rate (TRR)
for safety incidents for the past three years?*
Workers Compensation Experience Modification Rate (EMR) for the past three years?*
Commercial general and automobile liability insurance with limits of 2mm or greater?*

Where did you learn about Tyson Foods, Inc. Supplier Diversity Program?  (Check all that apply.)
Expo Women Council
Minority Council Other:

Please identify the geographical area served (Check all that apply.)

Annual Sales (past 3 years):*
$ Year 1 (most recent complete fiscal year)
$ Year 2
$ Year 3
Number of Employees:*
Number of Minority Employees:*
Year Company Established:*
Major Customers:*
Customer Name
Contact Name
Phone Number

Are you an existing Tyson Foods, Inc. Supplier?*
If yes, please indicate which business units or organization of Tyson Foods you have conducted business with in the last 24 months. Also list the product/service
Business Unit/Organization
Buyer/Contact Name