Diversity Supplier Registration Form

Instructions: Complete applicable fields. Hit the submit button when done, the application will automatically be submitted to Omega World Travel's Diversity Supplier manager.

Completing the supplier registration form is not a guarantee of business. The information provided will be used to determine if there is an opportunity for Omega World Travel to purchase products and services from your company.
Company Information
Company Name
Doing Business As: 
Contact's Name:
Contact's Title: 
Contact's Phone:
Contact's Email: 
Main Phone:
Main Fax: 
Website Address:
Company Email: 
Company Address:
 City: 
     State: 
Zip: 
Gross Sales:
 Business Start Date: 
    Years in Business: 
Primary SIC Code:
NAICS Code: 
Category:
Current Omega World Travel Supplier? 
  YES: 
NO: 
DUNS Number:
UNSPSC Code: 
Service Scope:
Business Status: 
Insurance: 
Tax ID Number:
  Product of Service Description:
 
  Are any members of your company's Management team related to an Omega World Travel Employee? Explain:
 
Ownership Please tell us what diversity category the ownership of your company falls in:
 
Caucasian Female   Minority Male   Minority Female
 
Small Business
Historically Black College/University HUB Zone Service Disabled Veteran-Owned
  Certification Agency Name List up to three certifying agencies for designations selected above
 
Certifying Agency Name Certification Number Expiration Date
References
 
Company Contact Phone