Supplier Information Form

Save & Return

Save your progress and complete this form later. (optional)

Type of Service? *
Your products will ship? *
What products will you be supplying us (check all that apply)? *

Domestic Shipping Information

International Shipping Information

Notice:  The Seafood Import Monitoring Program (SIMP) took effect on January 1, 2018.  The program establishes, for imports of certain seafood products, reporting and recordkeeping requirements needed to prevent illegal, unreported and unregulated (IUU) caught and/or misrepresented seafood from entering US commerce.  You must send us all required and mandatory information prior to entry into the United States.

ACH Set Up (International Suppliers Only)

FDA Inspected Facility

USDA Inspected Facility


Please Note:
1.  Copies of HACCP compliance certificate must be submitted electronically with the supplier information form.
2.  All non US Companies/Facitlities must also submit a copy of all their HACCP plans electronically with the supplier information form.
3.  Copies of all Certificates of Origin must be submitted electronically with the supplier information form (if applicable)

Is your company FSMA compliant with the Food Modernization Act? *

Third Party Audit or GFSI Certification

Shellfish Shippers Only

Certifications and Memberships

Farmed Fin Fish Feed Statement

Trace Register Membership

Labor and Human Rights Policy

Forced Labor:  Verification is necessary to confirm that you will not, supply us with any products, goods, services or raw materials produced by forced or slave labor.  In addition, none of the ingredients, additives or feed used to produce your products have been produced by forced or slave labor.
I have read and agree to the terms of the Labor Policy *

Certificate of Insurance

Product Integrity and Shelf-Life

We will not sell Fortune International or any of it's subsidiaries any product that is short in weight or count, that has the wrong name, or that has been transshipped from one country to another to circumvent duties and tariffs. *

Minimum Shelf Life (MSL) is the amount of shelf life left on a product upon receipt by Fortune International. Products purchased which are intended to be redistributed, are required to have at least 75% or more of the manufacturer’s maximum stated shelf life remaining at the time of receipt. Due to the nature of certain products, exemptions can be made only after a representative of Fortune International, LLC and vendor have negotiated a guaranteed shelf life before product is received.

Products arriving with less than 75% of Guaranteed Shelf Life upon delivery will be rejected, and the vendor will be responsible for transportation costs back to the original shipping facility.

Example of Minimum Guaranteed Shelf Life

Product with a 365 days shelf life, should be received by Fortune Fish & Gourmet with a minimum of 273 days at the time of receipt. (365 days x 75% =273 days).

I have read and agree to the Minimum Shelf-life policy *

Recall Procedure

In case of a recall, the following individuals must be notified by e-mail immediately at  for the Chicago Office and for the Minnesota Office.  If a response is not reurned within 5 minutes you must call until you speak to one of them.  You may not communicate to us by fax or leave a message on our answering machine.
Chicago Office (
Don Lairsey, Director of Continuous Improvement - 630-542-7599
Dominick Gattuso, CFO - 773-617-5903
Jeff Goldberg - 630-624-1665
Mark Palicki, President - 630-303-8391
Danielle Charette, VP of Sales - 773-619-0988
Jon Rezny, VP of Purchasing - 773-842-4062
I have read and agree to the recall procedure *

Vendor Approval Process

This is the second step and an annual step in our vendor approval process.  There will still be a probationary period of 90 days to insure you are meeting our requirements.  It is the supplier's responsbility that all suppliers' employees understand and comply with these documents.
By signing this you are confirming that you have attached and sent all of the information requested and are agreeing to all of the items listed above. Supplier Authorized Signature: *
Submit To: *
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