EmailMe Form - CNH Industrial

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Instructions

PLEASE READ BEFORE CONTINUING

If you need to save your information and return to complete the tool at a later time, scroll to the bottom of this online application click the "Save & Resume link." You will then have (seven) 7 days to return to the application for completion.

Fields marked with an asterisk are mandatory.

Please direct your questions to the Supplier Diversity Department at (XXX) XXX-XXXX.

GENERAL

SIDAT Unique ID

Date Time *

MM / DD / YYYY HH : MM AM/PM

CNH Industrial Supplier ID *

If not applicable, enter N/A

Company Name *

DBA *

If not applicable, enter N/A

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Country Code *

Phone *

### - ### - ####

Fax *

### - ### - ####

Web Site *

Primary Contact Name *

Prefix First Last Suffix

Primary Contact Title *

Primary Contact Email *

Confirm

Secondary Contact Name *

Prefix First Last Suffix

Secondary Contact Title *

Secondary Contact Email *

Confirm

OWNER

Owner Ethnicity *

Owner Gender *

COMPANY

Diverse Business? *

Legal Structure *

Diverse Business Category *

Federal Tax ID # *

DUNS # *

Year Established *

# of Employees *

Sales Volume *

$ Dollars . Cents

Sales Description *

Company Spend *

$ Dollars . Cents

National Minority Supplier Development Council (NMSDC) Certified? *

Women's Business Enterprise National Council (WBENC) Certified? *

Central Contractor Registration (CCR)? *

CCR Profile Expiration Date *

MM / DD / YYYY

Enter 11/22/33 if not applicable.

Certification Source 01 *

If you select City of, County of, State of, or Other, you will be required to list the specific location/organization in Certification Source 01-1.

Certification Source 01-1 *

If you selected City of, County of, State of, or Other above, please list the specific location/organization here. If not applicable, list N/A.

Certification Diverse Category 01 *

Certified or Classified 01 *

If you are not certified as, but rather classified as one of the above categories, please select "Classified."

Certification Expiration Date 01 *

MM / DD / YYYY

If not applicable, enter 11/22/33.

Certification Number 01 *

If not applicable, enter N/A.

Certification Source 02 *

If you select City of, County of, State of, or Other, you will be required to list the specific location/organization in Certification Source 02-1.

Certification Source 02-1 *

If you selected City of, County of, State of, or Other above, please list the specific location/organization here. If not applicable, list N/A.

Certification Diverse Category 02 *

Certified or Classified 02 *

If you are not certified as, but rather classified as one of the above categories, please select "Classified."

Certification Expiration Date 02 *

MM / DD / YYYY

If not applicable, enter 11/22/33.

Certification Number 02 *

If not applicable, enter N/A.

Certification Source 03 *

If you select City of, County of, State of, or Other, you will be required to list the specific location/organization in Certification Source 03-1.

Certification Source 03-1 *

If you selected City of, County of, State of, or Other above, please list the specific location/organization here. If not applicable, list N/A.

Certification Diverse Category 03 *

Certified or Classified 03 *

If you are not certified as, but rather classified as one of the above categories, please select "Classified."

Certification Expiration Date 03 *

MM / DD / YYYY

If not applicable, enter 11/22/33.

Certification Number 03 *

If not applicable, enter N/A.

Certification Source 04 *

If you select City of, County of, State of, or Other, you will be required to list the specific location/organization in Certification Source 04-1.

Certification Source 04-1 *

If you selected City of, County of, State of, or Other above, please list the specific location/organization here. If not applicable, list N/A.

Certification Diverse Category 04 *

Certified or Classified 05 *

If you are not certified as, but rather classified as one of the above categories, please select "Classified."

Certification Expiration Date 04 *

MM / DD / YYYY

If not applicable, enter 11/22/33.

Certification Number 04 *

If not applicable, enter N/A.

Certification Source 05 *

If you select City of, County of, State of, or Other, you will be required to list the specific location/organization in Certification Source 05-1.

Certification Source 05-1 *

If you selected City of, County of, State of, or Other above, please list the specific location/organization here. If not applicable, list N/A.

Certification Diverse Category 05 *

Certified or Classified 05 *

If you are not certified as, but rather classified as one of the above categories, please select "Classified."

Certification Expiration Date 05 *

MM / DD / YYYY

If not applicable, enter 11/22/33.

Certification Number 05 *

If not applicable, enter N/A.

Certification Source 06 *

If you select City of, County of, State of, or Other, you will be required to list the specific location/organization in Certification Source 06-1.

Certification Source 06-1 *

If you selected City of, County of, State of, or Other above, please list the specific location/organization here. If not applicable, list N/A.

Certification Diverse Category 06 *

Certified or Classified 06 *

If you are not certified as, but rather classified as one of the above categories, please select "Classified."

Certification Expiration Date 06 *

MM / DD / YYYY

If not applicable, enter 11/22/33.

Certification Number 06 *

If not applicable, enter N/A.

Certification Source 07 *

If you select City of, County of, State of, or Other, you will be required to list the specific location/organization in Certification Source 07-1.

Certification Source 07-1 *

If you selected City of, County of, State of, or Other above, please list the specific location/organization here. If not applicable, list N/A.

Certification Diverse Category 07 *

Certified or Classified 07 *

If you are not certified as, but rather classified as one of the above categories, please select "Classified."

Certification Expiration Date 07 *

MM / DD / YYYY

If not applicable, enter 11/22/33.

Certification Number 07 *

If not applicable, enter N/A.

Certification Source 08 *

If you select City of, County of, State of, or Other, you will be required to list the specific location/organization in Certification Source 08-1.

Certification Source 08-1 *

If you selected City of, County of, State of, or Other above, please list the specific location/organization here. If not applicable, list N/A.

Certification Diverse Category 08 *

Certified or Classified 08 *

If you are not certified as, but rather classified as one of the above categories, please select "Classified."

Certification Expiration Date 08 *

MM / DD / YYYY

If not applicable, enter 11/22/33.

Certification Number 08 *

If not applicable, enter N/A.

Certification Source 09 *

If you select City of, County of, State of, or Other, you will be required to list the specific location/organization in Certification Source 09-1.

Certification Source 09-1 *

If you selected City of, County of, State of, or Other above, please list the specific location/organization here. If not applicable, list N/A.

Certification Diverse Category 09 *

Certified or Classified 09 *

If you are not certified as, but rather classified as one of the above categories, please select "Classified."

Certification Expiration Date 09 *

MM / DD / YYYY

If not applicable, enter 11/22/33.

Certification Number 09 *

If not applicable, enter N/A.

Certification Source 10 *

If you select City of, County of, State of, or Other, you will be required to list the specific location/organization in Certification Source 10-1.

Certification Source 10-1 *

If you selected City of, County of, State of, or Other above, please list the specific location/organization here. If not applicable, list N/A.

Certification Diverse Category 10 *

Certified or Classified 10 *

If you are not certified as, but rather classified as one of the above categories, please select "Classified."

Certification Expiration Date 10 *

MM / DD / YYYY

If not applicable, enter 11/22/33.

Certification Number 10 *

If not applicable, enter N/A.

SIC 01 *

SIC 02 *

SIC 03 *

SIC 04 *

SIC 05 *

NAICS 01 *

NAICS 02 *

NAICS 03 *

NAICS 04 *

NAICS 05 *

NAICS 06 *

NAICS 07 *

NAICS 08 *

NAICS 09 *

NAICS 10 *

General Product/Service Description

Primary SIC Description

Primary NAICS Description