Husch Blackwell believes that diversity, equity, and inclusion are essential for not only the strength of our business, but also the vitality of the communities we serve. Research shows that a focus on diverse suppliers has a high return on investment and increases competition, which cultivates the innovation of new and improved products and services as well as benefitting the communities in which we are located.

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* Business Name:

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* Tax ID #:

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* Contact First Name:

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* Contact Last Name:

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* Contact Email:

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* # of Employees:

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* Check all that apply:

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* If your business is at least 51% owned, controlled, and actively managed by any of the following, please check all that apply:

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* If Minority-Owned, please check all that apply:

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* Check your certifying agency or agencies self-certification (thru affidavit):

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* Certification Expiration Date:

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* Please upload a copy of your certification or signed self-certification affidavit.
If you do not have a self-certification affidavit, please use this form: Download form.

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