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Application/Questionnaire

Please check one:
Current Safeway Inc. Supplier   
Prospective New Supplier
Company Name:
Address:
City:
State:    Zip:   
Telephone:
Fax:   
Contact Person:
Email Address:
Web Address:
Federal Tax I.D.:
Type of Business:
 
Brief Description of Type of Business, Product, or Service:
 
If manufacturer of resale item, what is the manufacturer portion of your Universal Product Code (UPC) Number:
- - 00000 (Ex. 1-23456-00000)
If current supplier/vendor, what is Safeway vendor number:
Geographic Market
Year Business Established
(Ex. mm/dd/yy)

Please indicate whether your company is a minority and/or women owned business:

We define a minority-owned or women-owned business as one:
• that is at least 51% owned by minorities or women,
• whose management and daily business operations are controlled by one or more women or members of a minority group, and
• that, if publicly owned, has one or more women or members of a minority group owning 51% (or controlling share) of the stock.
Please Check :
African-American or Black
Asian or Pacific Islander
Hispanic American
Native American (American Indian or Alaskan Native)
Women-Owned
Are you a Certified Minority or Women Owned Business:    Yes No
If so, list agency:
Certification Expiration:     (Ex. mm/dd/yy)
   

If you have any additional questions please send to Supplier.Diversity@Safeway.com
Although the preferred route is electronically, if you prefer to mail or fax in this questionnaire please send to:

Safeway Corporate Office
Supplier Diversity/Questionnaire
5918 Stoneridge Mall Road
Pleasanton, California 94588-3229
Fax : (925)467-3323