Untitled Document

Please select one:
Current Safeway Inc. Supplier
Prospective New Supplier

Contact Information

Company Name:
Address:
City:
State:
Zip:
Telephone:
Fax:
Contact Person:
E-mail Address:
Web Address:

Business Information Federal Tax I.D.:
Type of Business:
Geographic Market:
Year Business Established: (mm/dd/yy)

Brief description of type of business, product, or service:

If manufacturer of resale item, please enter the manufacturer portion of your Universal Product Code (UPC) #:
- - 00000 (Ex. 1-23456-00000)

If current supplier/vendor, please enter your Safeway vendor number:

Business Qualifications

Please indicate whether your company is a minority and/or women owned business:

We define a minority-owned or women-owned business as one:

that is at least 51% owned by minorities or women,
whose management and daily business operations are controlled by one or more women or members of a minority group, and
that, if publicly owned, has one or more women or members of a minority group owning 51% (or controlling share) of the stock.

Please check:
African-American or Black
Asian or Pacific Islander
Hispanic American
Native American (American Indian or Alaskan Native)
Women-Owned

Are you a Certified Minority or Women Owned Business? Yes No
If so, list agency:
Certification Expiration: (mm/dd/yy)

If you have any additional questions please send to supplier.diversity@safeway.com
Although the preferred submission route is electronic, if you prefer to mail or fax in this questionnaire please:

Click here to print a copy of this page
Complete this printed form and mail to:
Safeway Corporate Office
Attn: Miguel Sanchez
5918 Stoneridge Mall Road
Pleasanton, California 94588-3229
Fax : (925)467-3323

Supplier Questionnaire