Supplier Expression of Interest

PART 1 – Supplier Information

1.1 Business Details

Registered Business Name: *

Trading As:

ACN No.:

ABN No.: *

Registered Trading Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Postal Address: *

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Contact Number:*

Fax:

Company Type:

E-mail:

Date Business Commenced:

Are you an Aboriginal Business? *

An Aboriginal Business may be:

A sole trader, if the sole trader is an Aboriginal Person
A partnership or firm where at least 51% of the partners are Aboriginal persons
A corporation, where Aboriginal persons own at least 51% of the corporation

Are you registered on the Aboriginal Business Directory WA? *

If so, when did you register?

If you are an Aboriginal Business, are you:*

Please indicate your language group(s):*

Whadjuk

Noongar

Other

1/4

2.1 Please provide details of two recent projects

Project 1

Project 1 Client Name:

Project 1 Project Location:

Project 1 Scope of Work:

Project 1 Project Duration (months):

Project 1 Contract Value ($):

Project 1 Client Contact Name:

Project 1 Contact Position:

Project 1 Contact Phone:

Project 1 Contact Email:

Project 2

Project 2 Client Name:

Project 2 Project Location:

Project 2 Scope of Work:

Project 2 Project Duration (months):

Project 2 Contract Value ($):

Project 2 Client Contact Name:

Project 2 Contact Position:

Project 2 Contact Phone:

Project 2 Contact Email:

11.1 Does your company currently have Quality Management System compliance with a recognised national or international standard such as the ISO AS/NZS 9001?*

Name: *

Position: *

Email:*

Phone Number:*