*   = required
*Company Name:  
Address:  
City:  
State/Province:  
Postal Code:  
Country:  
*First Name:  
*Last Name:  
*Job Title:  
*Phone:  
Fax:  
*Email:  
Website URL:  
D&B Number:  
*Type of Business:  
Primary Products & Services:  
*Commodity Group:  
*Diversity Supplier:
% of sales which are automotive:   %
What % of automotive are powertrain/drivetrain components:   %
Select all countries that you currently manufacture in:  
 
Select all countries that you currently export to:  
 
Total Annual Sales in U.S. Dollars:  
Number of Employees:  
Are you privately or publicly owned?  
Top three Customers:  
Customer Name % of Sales
%
%
%
What are your quality certification(s)?  
 
If other, Please specify:  
What diversity certifications do you have?  
 
If other, Please specify:  
Comments or Questions (Please be as specific as possible.)