E3: Economy, Energy and Environment

Green Supplier Network Manufacturer Commitment Form

To qualify as a Green Suppliers Network manufacturer, your company must:

Be a manufacturer.
Undergo an assessment at a facility located in the United States.

If you do not see a confirmation acknowledging the form was submitted, please email Green_Suppliers@epa.gov.

My manufacturing company qualifies and is ready to join. We intend to:

Participate in a confidential Green Suppliers Network assessment.
Implement recommended environmental improvements, as appropriate.
Complete a NIST MEP follow-up survey one year after the review to measure results.

Yes we qualify and are ready.

Yes

First Name (Required)

Last Name (Required)

Title

Company Name (Required)

Address Line 1: (Required)

Address Line 2:

City (Required)

State (Required)

Zip (Required)

Phone (Required)

Phone Ext.

Email (Required)

Where is the facility at which you would like an assessment to be conducted (e.g., city and state)? (Required)

Which industry sector do you supply (e.g., automotive, aerospace, healthcare/pharmaceutical, office furniture)? (Required)

What are your major product lines (e.g., automotive parts, furniture components, utility poles)? (Required)

How did you hear about us? (Required)

If you were nominated by a large manufacturer working to green its supply chain, please provide contact information.

I am the large manufacturer nominator.

Nominator First Name

Nominator Last Name

Nominator Company Name

Nominator Email Address

E3's Green Suppliers Network may use my company name and location on the E3 website and other program materials. No other company information will be distributed without permission. (Required)

Yes

Leave this field blank