SUPPLIER DETAILS

New Supplier RequestChange of details to an existing vendor

Please complete all 4 sections.

Change details

Company Name and DetailsDescription of Goods and ServicesAddressCompany Contact details / WebsiteSales ContactCommercial ContactCredit AmountRemittance DetailsEvaluation Questionnaire - GeneralEvaluation Questionnaire - CommercialEvaluation Questionnaire - QualityEvaluation Questionnaire - Delivery ProcessEvaluation Questionnaire - Safety PerformanceEvaluation Questionnaire - Supply Chain MattersEvaluation Questionnaire - Local ContentEvaluation Questionnaire - Environment

SECTION 1 - SUPPLIER DETAILS

Registered Supplier Name *

Company Legal Entity Name *

Trading Name *

Business Unit

ABN *

GST Registered *

YesNo

Description of good/s services to be supplied *

Business Address

Street address *Street address line 2

City

State

Postcode *

Country

Postal Address

The same as Business Address

Street addressStreet address line 2

City

State

Postcode

Country

Company Contact Details

Accounts Receivable Contact Name *

Phone Number *

Accounts Email *

Website

Company Phone Number *

Company Email *

Sales Contact Name *

Sales Phone Number *

Sales Email *

Commercial Contact Name *

Commercial Phone Number *

Commercial Email *

Credit Amount *

Powertech’s standard payment term is 30 days from the date the Invoice is received.

Please submit all correspondence, including invoices, statements, and queries to accounts.mailbox@powertech.com.au.

Please quote our Powertech Pty Ltd Purchase Order Number on all Invoices.

YOUR POWERTECH CONTACT *

SECTION 2: REMITTANCE DETAILS

Remittance Email Address *

For EFT/Direct deposit payments, please complete banking details below. Please be careful in providing the correct account details as Powertech Pty Ltd will not accept any responsibility for any delays arising from incorrect/missing account details.

Account Name *

Account Number *

Bank/Institution *

Branch *

BSB

Currency *

SWIFT Code (INT Payment)

Bank Phone Number

Please upload a copy of any of the below as proof of account details. Check the item provided.

Bank StatementBank details on company letterheadBank deposit slipInvoice with bank detailsOther

Browse

Please upload copy of the Sales Terms and Conditions *

Browse

SECTION 3: SUPPLIER EVALUATION QUESTIONNAIRE

Please respond to the questions below:

YesNo

1. As provided in section 1, is supply of the aforementioned items/services part of your core business?

YesNo

2. Is your business WA or QLD owned & operated?

YesNo

2.1 If not, is your business Australian owned & operated?

YesNo

3. Is your business indigenous owned and operated?

YesNo

3.1 If not, does your company support indigenous employment & businesses?

YesNo

4. Is there a WA branch and a QLD branch?

YesNo

5. Do you keep stock in WA & QLD?

YesNo

YesNoN/A

6. Do you keep spare parts in WA and QLD (if relevant)?

YesNoN/A

YesNo

7. Would you be heavily dependent on our business?

YesNo

COMMERCIAL

YesNo

1. Is an account with 30 day payment terms available?

YesNo

2. Do you use/require purchase orders?

YesNo

3. Is there a discount structure for volume purchases? (If yes, attach details)

YesNo

4. Are pricelists available? (If yes, attach details)

YesNo

5. Is it possible to order and track order progress online?

YesNo

If item 1 is yes, please attach Terms & Conditions, and credit application form.

If Item 5 is yes, please provide access details.

6. What is the warranty period? *

QUALITY

YesNo

1. Is your organisation quality certified to ISO 9001:2015?

YesNo

2. Does your organisation monitor the percentage of goods rejected by its customers?

YesNo

If so, what percentage of goods of this type has been rejected over the last twelve months?

YesNo

3. Do you have a customer feedback process?

YesNo

4. Does your organisation notify its customers immediately if it finds that a promised delivery date cannot be met?

YesNo

YesNoN/A

5. Is technical support available (where relevant)?

YesNoN/A

6. What is the process for conflict resolution? *

7. Who do we deal with in such cases (name and contact details)? *

8. Please provide contact details for a customer who can give a reference on your products/services. *

DELIVERY PROCESS

1. What freight companies do you normally use? *

2. What is the normal delivery time from order placement? *

3. What is your on-time delivery percentage? *

SAFETY PERFORMANCE

YesNo

1. Do you have an OHS Management system accredited to an external safety standard, e.g. ISO 45001?

YesNo

2. Have you incurred any legislative breaches, fines or improvement notices?

YesNo

If so, please provide details below:

3. Please provide a 3-year history of your safety statistics:

Year 1

Medical Treatment Injuries *

Medical Treatment Injury Frequency Rate *

Lost Time Injuries *

Lost Time Injury Frequency Rate *

Year 2

Medical Treatment Injuries *

Medical Treatment Injury Frequency Rate *

Lost Time Injuries *

Lost Time Injury Frequency Rate *

Year 3

Medical Treatment Injuries *

Medical Treatment Injury Frequency Rate *

Lost Time Injuries *

Lost Time Injury Frequency Rate *

SUPPLY CHAIN MATTERS

YesNo

1. Will the goods be sourced/manufactured in Australia?

YesNo

Where will they be sourced/manufactured?

YesNo

2. Do you have a policy in regard to Ethical Procurement practises?

YesNo

3. Do you have a Bribery and Anti-Corruption policy?

YesNo

4. Do have a Modern Slavery / Human Rights Policy aligned to UN Guiding Principles?

YesNo

5. Do you have a Code of Business Conduct Policy?

YesNo

6. Do you have a policy around Worker Welfare and allowing employees to raise grievances without fear of retaliation?

YesNo

7. Do you have a Harassment and Anti-Discrimination Policy?

YesNo

8. Do you agree to provide Powertech with notification regarding major changes to your supply chain?

YesNo

9. Do you agree to take part in ongoing supplier performance evaluations?

YesNo

10. Has the company ever been in breach of any legislation, regulatory or statutory requirement?

YesNo

11. Do you monitor customer satisfaction through a Net Promoter Score?

YesNo

LOCAL CONTENT

YesNo

1. Do you have a commitment to employment of local workers?

YesNo

2. Do you have a plan to manage social impacts and enhance benefits to local communities?

YesNo

ENVIRONMENT

YesNo

1. Do you have an Environmental Policy?

YesNo

2. Do you have a Carbon Neutral Target/Plan?

YesNo

3. Have you had any Environmental breaches?

YesNo

4. Do you have a policy around enhancing Environmental Sustainability?

YesNo

SECTION 4: DECLARATION

I/WE confirm that the details supplied above are true and correct.I/WE agree to Powertech Pty Ltd's Terms and Conditions and Supplier Guiding Principles. All required supporting documentation is attached.

*

Authorised Person *

Position *

Date *

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