Application #:
Columns marked as * are mandatory
Business Address
* Name of Company:  
* Address:  
* City:  
* State:  
* Zip:  
* Phone:    
* Fax:    
* Email:    
* Website:  
Business Info
* Business Entity Type:
* Business TaxID:  
Tax Type:
Year Established:
No. of Employees:
No. of Minority +
Female Employees:
* Annual Sales ($):  
 
PRINCIPAL OWNER(S) OF COMPANY
Name Title % Ownership Ethnicity Gender Disabled
BUSINESS CLASSIFICATION(S)
MBE
WBE
DBE
VOB/SDVOB
PWD (Disabled)
LGBT
 
Contact Identification
* Contact Name:  
* Title:  
* Address:  
* City:  
* State:  
* Zip:  
* Phone:    
* Fax:    
* Email:    
Description of Product or Service
Please click here to review list of products or services purchased by MGM Resorts and enter appropriate commodity code(s) below:

Select items in the list and hit the 'Remove From List' button to remove items from this list.

Product Qualification Status:
 
PRODUCT PROFILE

This product profile section enables you to define the types of goods and services your company provides in more detail. The information entered here will be accessed by MGM Resorts buyers using a "keyword browse" feature. Please use this section to help us easily identify your company during the sourcing process.

 
Client References
Company Name Contact Telephone Number
       
 
 
MBE/WBE/DBE Certification
Certification agency:
(Image should be lessthan or equal to 2MB)
Expiration date (mm/dd/yy):
Application date, if not currently certified (mm/dd/yy):
ACKNOWLEDGMENT

Please initial in the box below acknowledging that you are a company official and that all information is correct. Be advised that any false representation of your company as a minority or woman-owned business will result in immediate disqualification from the MGM Resorts Purchasing and Construction Diversity Program. It is your responsibility to notify MGM Resorts of any changes to the information provided.

*  Initials:  
* Name:  
* Title: