Supplier Profile Information
 
This supplier information is for planning purposes only and should not be construed as a solicitation or as an obligation on the part of Midwest ISO. Midwest ISO is not obligated to enter into any contract or agreement on the basis of responses to this supplier application. Submitting this information to Midwest ISO is for information purposes only and does not bind either Midwest ISO or you to any agreement. Acceptance of this supplier application by Midwest ISO does not constitute the granting of any contract or agreement. Midwest ISO enters into contractual relationships only by executing explicit written agreements.
I have read the above terms and conditions, and by clicking the "Submit!" button below, I agree to these terms and conditions and certify that the information supplied in this application is true, complete, accurate, and current.
 
 Primary Information Fields with asterisk (*) are required  
 Business Name:*
 Federal Tax ID:*
Years Doing Business As Such:  
 Business Type:* IT    Non-IT
 Former Name:
 Parent Company:
 Brief Company Overview:*
 Short Overview of Business Focus:    Annual Sales: $       Annual Revenue: $
 Percentage of Sales: Hardware Resell Software Resell Services Proprietary Hardware Proprietary Software
 
 Customer Base /  Current
 Contracts: (please emphasize
 experience  in utility and/or
 energy industry
 Dunns Number:*
Organization Type:*  
 HQ Address:*
Street Address* City* State* Zip Code* Phone*
 Other Locations:
(Address & Phone)
 Web site:*      Number of Employee:    

 Turnover or three year staffing trend: 

 Relationship with the participating companies?*               Yes    No    (if Yes, list company name(s) in the boxes below)
 
 
 Midwest ISO Contacts/Referrals:
 
 Business Specifics
OEM Partner
   
 Product partnerships/
 Resell information
 (list all that apply):
 Your company's area of
 strength - please tell us the
 products and services that
 constitutes your core offering
 and highlight why the Midwest
 ISO should contact you to learn
 more.
 
 Your company's competitive landscape:
 
 Diversity Information  
A woman-owned business enterprise (WBE) and a minority-owned business enterprise (MBE), under the Midwest ISO Supplier Diversity Program, are defined as an organization that is at least 51 percent owned, managed, and controlled by one or more women or minority persons who are United States citizens.  For puposes of this definition, minority group members are Woman, African Americans, Hispanic Americans, Asian Americans, Native American Indians, Alaskan Native, Native Hawaiian and other Paciifc Islanders , Small Disadvantaged and Disabled American Veterans.
   
 Minority Owned *
Yes    No
  
Ethnicity: *
 African American
Native American 		Asian Pacific American
Subcontinental Asian American		 Hispanic American
Other
   
   

 Ownership (Select all that apply):

   National Minority Supplier Development Council Certified *
Woman-Owned Yes    No 
American Veteran-Owned  
Service Disabled Veteran-Owned  Women Business Enterprise National Council Certified *
Nat'l Assoc. Woman Business Owners Member Yes    No
Small Disadvantaged Business  
       
 
 Industry Certificates, Accolades, Recognitions:
 
 Primary Contact Information
 Name:*
 Office Phone Number:*  Cell Number:
 Email Address*  Years with company:*