Supplier Diversity Intake Form

What is a Minority-owned Business Enterprise (MBE) or Women-owned Business Enterprise (WBE)?

An MBE or WBE is a for-profit enterprise located in the United States that is ownered, operated and controlled by a minority group member or woman and meets all the following criteria:

  • At least 51% ownership of business by a minority group member or women
  • If a publicly owned business, at least 51% of the stock is owned by one or more minority group members or women.
  • Management and daily operation of the business are controlled by those minority group members or women
  • Business must be located in the United States or its trust territories
  • The minority group members or women must be U.S. citizens
Company Information
* indicates required fields
Company Name *
Address 1*
Address 2
City*
State*
Zip/Postal Code*
Phone:*
Toll Free Phone #:
Fax:
Email:*
Website:
Contact Information
Contact Name:*
Title:*
Phone:*
Fax:
Email:*
Business Information
Business Type *
NAICS Code:*
Federal Tax ID:*
Tax Type *
Year Established:*
Year Incorporated:
Number of Employees:*
Warehouse Space (sq. ft):
Geographic Service Area *
Annual Sales (last year):*
Annual Sales (2 years ago):
Annual Sales (3 years ago):
Please provide a brief description of the product / services your firm provides:*
Current Andrews International Supplier?*
If a current Andrews International supplier, enter your vendor #:
Principal Owners
Owner Name:*
Title:*
% Ownership*
Ethnicity: *
Gender: *
References (Corporate Customers)
Company:*
Contact Person:*
Telephone:*
Company:*
Contact Person:*
Telephone:*
Company:*
Contact Person:*
Telephone:*
M/WBE Certification

To be considered for Andrews International's Supplier Diversity Program, we require current certification of minority or woman ownership status. We accept certification from the National Minority Supplier Diversity Council (NMSDC) and it’s regional affiliates, the Women’s biz Enterprise National Council (WBENC) and it’s regional affiliates, or the appropriate Local, State or Federal agency.

Certification Document must be received within 90 Days of submission of Supplier Diversity Form.

Copies of your current certification certificate or application, and marketing brochures or other printed materials outlining products and services should be mailed to:

Ms. Marla Gibson
Vice President, Human Resources/Corporate Diversity
Andrews International
455 N. Moss Street
Burbank, CA 91502
818-842-6595
M/WBE Certifying Agency: *
If current, enter expiration date (mm/dd/yyyy):
If pending, enter date applied (mm/dd/yyyy):
Acknowledgement
Preparers Initials:*
Preparer's Name:*
Preparer's Title:*
Preparer's Phone #:*
Perparer's Email Address:*
Date:*