DemographicsSupplier Name(Required)Domestic/International?(Required) Domestic InternationalAddress(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email(Required) PhoneSelect Supplier Type Below(Required)Raw MaterialIngredientPackagingServiceService(s)(Required)LaboratoryLaundryPest ControlChemicalsConsultantWasteOtherProducts(Required)What do you supply Northern Wind – Please list the products you supply us.Other ServicePlease indicate the service you will provide.Are you GFSI Certified?(Required) Yes NoGFSI Certification(Required)BRCSQFIFSFSSC:22000BAP/BSPPrimusOtherExpiry Date(Required) MM slash DD slash YYYY GFSI Certification - OtherQuestionnaire (please mark your selections)Do you have a written food safety policy?(Required) Yes No N/AHas a food safety risk assessment been undertaken?(Required) Yes No N/ADo you have a food safety plan, product protection program, risk management plan, HACCP, or other food safety system?(Required) Yes No N/ADo you have an employee hygiene program?(Required) Yes No N/ADo you have Sanitation Standard Operating Procedures (SSOP's)?(Required) Yes No N/AAre personnel trained in food hygiene and safety?(Required) Yes No N/ADo you have a pest control program?(Required) Yes No N/AAre cross-contamination risks controlled?(Required) Yes No N/ADo you have a recall program?(Required) Yes No N/ADo you have full traceability?(Required) Yes No N/ADo you have a system for handling customer complaints?(Required) Yes No N/ADo you have a supplier approval program?(Required) Yes No N/AAre manufacturing instructions documented?(Required) Yes No N/ADo you carry out any auditing, either internal or external?(Required) Yes No N/ADo you carry liability insurance?(Required) Yes No N/ADo you have any other food safety controls in place?(Required) Yes No N/ASection 3: Allergen InformationPlease check all applicable selectionsMILK(Required) Yes NoIn Product? Yes NoIn Facility? Yes NoControlled? Yes NoEGGS(Required) Yes NoIn Product? Yes NoIn Facility? Yes NoControlled? Yes NoWHEAT(Required) Yes NoIn Product? Yes NoIn Facility? Yes NoControlled? Yes NoCRUSTACEAN SHELLFISH (lobster, crab, shrimp)(Required) Yes NoIn Facility? Yes NoIn Product? Yes NoControlled? Yes NoTREE NUTS(Required) Yes NoIn Product? Yes NoIn Facility? Yes NoControlled? Yes NoPEANUTS(Required) Yes NoIn Product? Yes NoIn Facility? Yes NoControlled? Yes NoFISH(Required) Yes NoIn Product? Yes NoIn Facility? Yes NoControlled? Yes NoSOY(Required) Yes NoIn Product? Yes NoIn Facility? Yes NoControlled? Yes NoSESAME(Required) Yes NoIn Product? Yes NoIn Facility? Yes NoControlled? Yes NoMOLLUSCAN SHELLFISH (clams, oysters, etc.)(Required) Yes NoIn Product? Yes NoIn Facility? Yes NoControlled? Yes NoCELERY SEED(Required) Yes NoIn Product? Yes NoIn Facility? Yes NoControlled? Yes NoMUSTARD SEED(Required) Yes NoIn Product? Yes NoIn Facility? Yes NoControlled? Yes NoGLUTEN(Required) Yes NoIn Product? Yes NoIn Facility? Yes NoControlled? Yes NoRequired DocumentsGFSI DocumentAccepted file types: pdf, Max. file size: 1 GB.If you have a contract on file, please upload it hereAccepted file types: pdf, Max. file size: 1 GB.Please upload your ISO CertAccepted file types: pdf, Max. file size: 1 GB.HACCP LetterAccepted file types: pdf, Max. file size: 1 GB.Migration StudyMax. file size: 1 GB.Trace Exercise (Please supply a trace exercise or commonly known as Mock Recall of any product you may produce, preferably one you sell to Northern Wind, LLC)Accepted file types: pdf, Max. file size: 1 GB.Section 4: AcknowledgementI hereby declare that to the best of my knowledge the answers contained within this form are true and accurate. I understand that the information will be used in the evaluation process to assess the named organization's suitability as a supplier.Service ProviderThe Service Provider hereby agrees to the following criteria in accordance with the terms and conditions set forth in this agreement: The Service Provider will consult with and advise the Customer regarding the following matters and the parties agree that the nature and description of service provided to the Customer shall be in accordance with the descriptions submitted to the Customer and agreed upon by both parties. Both parties agree to review and update descriptions any time there is a change to the services provided that impact the facility, equipment, processing methods, or raw materials as defined to meet specifications.Select AllService Provider's ObligationThe Service Provider agrees to provide the following items so that they meet defined Customer specifications: A list of ingredients or materials that need to be controlled upon receipt, during storage or shipping to avert issues which may jeopardize safety, legality or quality of goods located at the Customer's facility A copy of this signed and dated Service agreement by senior management. The Service Provider has reviewed the Customer’s specifications and agrees to the criteria set forth. Non-conformity of or goods or services by the Service Provider will be corrected in a timely manner. The Service Provider agrees not to bring into or use substances that may put at risk the safety, legality or quality of Customer goods.Select AllConfidential Information:(Required) The Service Provider agrees that any information received by the Customer during any furtherance of the Service Provider's obligation in accordance with this agreement, will be treated by the Service Provider in full confidence and will not reveal to any other person, firms or organizations.Consent(Required) By completing this form you are electronically signing this type of statement.Form Completed By:Name(Required) First Last Position(Required)Δ