Nissan Potential Supplier Profile Survey

Nissan values inclusion in all areas of our business as we strive to mirror the diversity of our customer base and the communities where we do business. We are committed to procuring innovative goods and service, retailing our cars, and communicating from a diverse perspective, which will help us continue to offer customers competitively designed, market-driven products.

Step 1 of 3: CONTACT INFORMATION

1.Company Information(Required.)

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP:

Country:

Email Address:

Phone Number:

2.Company Contact Information - If different from above

Contact Name:

Contact Title:

Address:

Address 2:

City/Town:

State:

ZIP:

Country:

Contact Email Address:

Contact Phone Number:

3.Year company established?(Required.)

4.Website Address

Step 2 of 3: COMPANY OVERVIEW

5.Company Structure

Sole Proprietorship

Corporation

Partnership

Joint Venture

Other (please specify)

7.Number of Employees(Required.)

8.Company Annual U.S. Sales - Last Year U.S. Dollars(Required.)

9.Forecasted Company Annual U.S. Sales - This Year U.S. Dollars(Required.)

10.Forecasted Company Global Sales - This Year - Exclude U.S. Sales(Required.)

11.Is your company union affiliated?

Yes

No

If yes, which union and expiration date

12.Identify all certifications that your company currently holds (Nissan currently recognizes NMSDC, WBENC & CAMSC certifications for diversity)

NMSDC - National Minority Supplier Development Council

WBENC - Women's Business Enterprise National Council

CAMSC - Canadian Aboriginal and Minority Supplier Council

NaVOBA - National Veteran Owned Business Association

NGLCC - National Gay & Lesbian Chamber of Commerce

SDVOSB - Service Disabled Veteran-Owned Small Businesses

None

Other (please specify)

13.List all diversity certification numbers

14.Dun & Bradstreet Number

15.SIC Code

16.W-9 Number

17.List three major customers

18.Are you a current supplier to any auto makers (OEM's)?

Yes

No

STEP 3 OF 3: PRODUCTS & SERVICES YOU PROVIDE

20.Powertrain Parts & Components

Not Applicable

Powertrain (Engine Components, Transmission Components)

Powertrain (Exhaust, Cooling, Catalyst, Engine Management System)

Other (please specify)

26.Machinery & Equipment

Not Applicable

Maintenance Equipment

Production Equipment

Other (please specify)

27.Logistics

Not Applicable

Logistics/Transportation

Other (please specify)

29.Is your company TS 16949 Certified?

Yes

No

30.Is your company ISO 14001 Certified?*

Yes

No

31.Is your company ISO 15001 Certified?

Yes

No

32.Is your company EDI Capability?

Yes

No

33.Describe advantages your products, materials or services offer to Nissan relative to quality, technology or cost

For more information or questions please contact:
supplierdiversity@nissan-usa.com