Supplier Information Form

This is the second step to the Vendor Approval process, the first step is to have permission from Fortune International to fill out this form. Please list the name of the Fortune employee that granted this permission. *

Save & Return

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

Type of Service? *

Food or Food Product Supplier

Non-Food Supplier (Equipment, Contractor, Freight, etc.)

Your products will ship? *

International

Domestic

What products will you be supplying us (check all that apply)? *

Fresh, Frozen, and/or Live Seafood / Fresh Meat

Gourmet Products (dairy, oils, spices, desserts, etc.)

Supplier Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Country *

FEIN *

Phone Number *

Fax Number *

Website

Sales Contact *

Sales Person Phone Number *

Sales Person Email Address *

Accounting Contact *

Accounting Phone Number *

Accounting Email Address *

Customer Service Contact *

Customer Service Phone Number *

Customer Service Email Address *

Logistics Contact *

Logistics Phone Number *

Logistics Email Address *

Quality Assurance Contact *

QA Phone Number *

QA Email Address *

Principle Products / Services your Company Provides *

Buyer *

Payment Terms *

Remit to Address (If different from above)

City

State

Zip Code

Country

Domestic Shipping Information

Pick-up Address *

Address Line 2

City *

State *

Warehouse Contact *

Phone Number *

International Shipping Information

Preferred Port

Country

Terms

Export Contact

Phone Number

Email

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)

IBAN

Currency

Bank Account

Swift Code

IBAN:

FDA Inspected Facility

FDA Registration #

SID# (If Applicable)

USFDA BioTerroism #

USDA Inspected Facility

USDA Number

HACCP

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)

Certificates of Origin

Certificate of HACCP Compliance

HACCP Plans *

HACCP Plans

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

Yes

No

Third Party Audit or GFSI Certification

Please include a copy of a current audit by a Third Party or your Global Food Safety Initiative (GFSI) Certification. If you do not have a current audit, upload your most recent internal audit and we will need to set-up a time for a tour of your facility. *

Shellfish Shippers Only

Interstate Shellfish Shipper #

Certifications and Memberships

Certifications (MSC, BAP, ISO, CCOF, USDA Organic, Kosher, GMO Free, etc.)

List of Certified Products

NFI, GAA, etc

Certificate of Analysis (COA) - Please include a copy of your COA including allergen information

Sustainability Report - Please include a copy of your sustainability report or policy

Farmed Fin Fish Feed Statement

If your supply us with farm-raised finfish, attach a feed statement for each species

Trace Register Membership

Trace Register Membership Number

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 *

Yes

Please attach a copy of your most recent third party social audit

Certificate of Insurance

Please attach your company's current 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. *

Agree

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 *

Yes

Recall Procedure

In case of a recall, the following individuals must be notified by e-mail immediately at quality@fortunefishco.net for the Chicago Office and MNquality@fortunefishco.net 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 (qualtiy@fortunefishco.net)

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 *

Yes

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: *

clear

Name: *

Title: *

Submit To: *

Fortune Imports