WBE Canada Corporate Member Application 2018/19
1. COMPANY INFORMATION
Company Name
Your answer
Company Address *
Your answer
Address 2
Your answer
City *
Your answer
State/Province *
Your answer
Postal Code/Zip *
Your answer
Country *
Your answer
2. PRIMARY CONTACT
This contact will be used for communication during the application and on-boarding process. This contact will be a primary representative of the organization at the WBE Canada's Annual Members Meetings. This contact will also be added to our exclusive Corporate Member list to keep you informed about any updates and opportunities.
Primary Contact Name *
Your answer
Job Title *
Your answer
Best Phone *
Your answer
Other Phone
Your answer
Fax
Your answer
Email *
Your answer
3. SECONDARY CONTACT
Contact of a person who will be the back-up contact in case you are away or unavailable.
Name *
Your answer
Job Title *
Your answer
Best Phone *
Your answer
Best Email *
Your answer
Do you want this contact to be added to our Mailing List to receive updates about initiatives and opportunities at WBE Canada? *
4. MEMBER PROFILE INFORMATION
Who should be listed in the online WBE Canada database accessed by all WBEs? *
If other, please let us know the Name, Title, Phone & Email of the person you want us to publish.
Name
Your answer
Title
Your answer
Best Phone
Your answer
Best Email
Your answer
Other Member Profile Information
Company Website *
Your answer
Supplier Diversity Website *
Your answer
May we feature public information from your website to describe your company in our database? *
If you answered NO to the above question, how do you want your company to be described?
Your answer
May WBE Canada link to your social media platforms?
Add links to the accounts you agree for us to link to.
Twitter
Your answer
LinkedIn
Your answer
Instagram
Your answer
Facebook
Your answer
Will you link your supplier information page on your website to wbecanada.ca? *
5. MARKETING CONTACT
Best contact for logo, marketing collateral, website updates, press releases, etc.
Name *
Your answer
Phone *
Your answer
Email *
Your answer
Do you want this contact to be added to our general communications list (newsletter)? *
6. SUPPLIER DIVERSITY INFORMATION
Tell us more about your company/organization and your supplier diversity initiatives.
Do you currently have a supplier diversity program? *
If you answered "No"...
What is your planned implementation schedule? (Month/Year)
Your answer
Would you like us to work with you to create a supplier diversity program?
If you answered "Yes", do you...
...require diverse suppliers to have third-party certification?
...include women-owned businesses among your diverse suppliers?
...accept WBE Canada certification?
...accept other certifications for WBEs?
What other certifications do you accept?
Your answer
What was your diverse spend with Canadian certified WBEs in your last fiscal year? *
How many certified WBEs did you purchase from in your last fiscal year? *
Do you currently track second and/or third tier diversity spend in your organization? *
How many of your 1st tier suppliers track and report their diverse spend? *
Are you planning to start tracking second and/or third tier diversity spend in your organization in the next 12 months? *
7. CORPORATE MEMBERSHIP INFORMATION
How did you hear about WBE Canada? *
Your answer
Industry *
Your answer
Products/Services produced or provided: *
Your answer
Products/Services purchased: *
Your answer
Can you provide in-kind support to WBE Canada? *
Membership dues (Select what applies) *
I UNDERSTAND THAT THIS APPLICATION IS CONSIDERED A COMMITMENT AND THAT MY CORPORATION WILL START RECEIVING MEMBERSHIP BENEFITS ACCORDING TO THE DATE MY APPLICATION IS RECEIVED. *
Purchase order number (if applicable)
Your answer
Billing address *
Your answer
CONTACT FOR PAYMENT PROCESSING
Who in your organization will be our go-to person for invoicing and payment processing? This contact will NOT be added to any distribution list.
Name *
Your answer
Telephone *
Your answer
Email *
Your answer
Additional comments about invoicing and payment processing
Your answer
If you have any questions, please contact Michelle Bianchi, VP Operations & Finance, 416-646-6233 or mbianchi@wbecanada.ca
Is there anything else you want us to know as we process your application?
Your answer
Today's Date *
MM
/
DD
/
YYYY
Authority *
Name of the person filling out the form *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of WBE Canada.