Supplier Diversity Verification

Please print and complete form including signature to acknowledge you are a company official and that all the information provided is correct. It is your responsibility to notify Kelly of changes to this information.

Kelly has given permission for this form to be transmitted by a variety of means including fax and e-mail. It is understood that this form will be deemed to have been "signed" and to constitute an "original" when printed by Kelly from electronic files or records transmitted by the MWDBE first named above (who will promptly provide an actual original upon Kelly's request).

Please send the completed verification and all necessary attachments (e.g., proof of business certification) by mail, fax, or e-mail to the following:

Thank you for completing the survey. Please make sure to send this verification form and your business certification within three days of completing the survey. Once we receive and review your survey, verification form, and business certification, we will notify you regarding your SDD status.