Schnucks Application Form 1Contact Info2Business Info3Personal Info Name(Required) First Last Title(Required) Business Name(Required) Business Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone Number(Required)Mobile Number(Required)Email(Required) Enter Email Confirm Email Website Business Ownership Status(Required) Private Public Please Describe:(Required) What Is Your Legal Business Structure?(Required) Sole Proprietorship LLC S-Corp C-Corp Corporation Non-Profit Undecided Is Your Business Owned by a US Citizen or a Permanent Legal US Resident?(Required) Yes No Does Your Business Qualify as Diverse Owned? Is it at least 51% Owned, Operated, and Managed by an Individual or Group that Fits in One or More of These Categories: Women Owned, Black American, Hispanic/Latino American, Asian American/Pacific Islander, Native American, LGBT Owned, US Military Veteran, or Disabled(Required) I Am the Majority (At Least 51%) Business Owner No Other Please Select The Diverse Business Categories That Describe Your Current Business (Select ALL That Apply)(Required) Woman Owned Black American Owned Hispanic/Latino American Owned Asian American/Pacific Islander Owned Native American Owned LGBT Owned US Military Veteran Owned Disabled Owned Other How Many Years Have You Been in Business?(Required) Under One Year 1-3 Years 4-6 Years 7-9 Years 10-12 Years 13-15 Years 16-20 Years 20+ Years Not Currently in Business What CPG Product Category Best Describes Your Business ?(Required) Baby Beauty, Personal Care, Hygiene Pet School, Office Supplies Automotive Cleaning & Household Essentials Beverages Food Accessories Other Briefly Describe The Product Your Business Offers In The Space Below:(Required)My Product is...(Required) Frozen Refrigerated Shelf-Stable What is the Shelf-Life of Your Product When it is at Ambient Temperature?(Required) Is Your Business...(Required) Business to Business (B to B) Business to Consumer (B to C) Both Not Sure Annual Company Revenue(Required) Under $10k $11-$50k $51-$100k $101k-$250k Over $250k Note: This information is confidential and will not be shared externally. It will be used to place you in the right tracks within the program modules.How Many Full-Time Employees Do You Have?(Required) How Many Part-Time Employees Do You Have?(Required) Do You Currently Have Any Diverse Business Certifications?(Required) Woman Business Enterprise (WBE) Minority Business Enterprise (MBE) Service Disabled Veteran Enterprise HUB Zone LGBT Enterprise VBE Disability IN USPAACC I Do Not Have Any Certifications If Yes, Please Select ALL That Apply. What Impact Do You Hope Participating In The Schnucks Program Will Have On You?(Required)What Impact Do You Hope Participating In The Schnucks Program Will Have On Your Business?(Required)Is There Anyone Else You Think Would Benefit From This Program?(Required) No Yes Please Provide Their Email Address And We Will Send Them Information. How Did You Hear About This Program?Choose One:T.V.RadioNewsSocial MediaWebsiteFriendOtherPlease Upload a Picture of Your ProductAccepted file types: jpg, gif, png, pdf, Max. file size: 2 GB.Consent(Required) I Agree Fully With the Policy Below:I affirm that the diversity information entered as part of this application process, including this form, is to the best of my knowledge true, accurate, and complete. Furthermore, I affirm that I am authorized to make this attestation on behalf of my company. I understand that Federal Law provides penalties for misrepresentation of owner status information. Further, I understand that this information may be used by Schnucks as part of its reporting and marketing efforts, and that any falsification or fabrication of information may adversely impact my company's ability to do business with Schnucks on an ongoing basis. I attest that if there are any changes to the information provided I will alert Schnucks and MSDC as soon as reasonably possible, but at least within thirty (30) days of the date such change became known to me or my company.CommentsThis field is for validation purposes and should be left unchanged. Δ
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