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Supplier Diversity Questionnaire

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.
Business Name:(Required.)
Tax ID #:(Required.)
Contact First Name:(Required.)
Contact Last Name:(Required.)
Contact Email:(Required.)
# of Employees:
Check all that apply:
If your business is at least 51% owned, controlled, and actively managed by any of the following, please check all that apply:
If Minority-Owned, please check all that apply:
Check your certifying agency or agencies self-certification (thru affidavit):
Certification Expiration Date:
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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Husch Blackwell reserves the right to verify any information provided. Additionally, any information provided may be submitted to local, state or federal agencies that mandate these regulations.
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