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Kimball Midwest
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Kimball Midwest - Register for the Supplier Diversity Program
Kimball Midwest is committed to supplier diversity. If you wish to be considered as a supplier, please complete the following form. Upon receipt, we will forward your company’s profile to the appropriate purchasing manager for entry into our database of interested suppliers. We reference this database for consideration of new products and suppliers.
Fields with an (*) are required to process your registration.

Corporate Information
Company Name: *
Address: *
City: *
State:     Zip Code:    *
Contact Information
Principal Contact: *
Title: *
Email Address:
Confirm Email:
Website Address:
Phone Number: *     Ext.:   
Fax Number:
Additional Information
Dun & Bradstreet Number:
Number of Employees: *  
Annual Revenue: *  
Year Founded: *  
Service Area:

Is your company a certified minority-owned business?
Small Business Classification:



How did you learn about our program? (2000 character maximum) Remaining Characters: 2000
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