ESS Australia

• General Contractor/Supplier Application Form

General Contractor/Supplier Application Form

* Asterisk denotes fields that must be completed

General Information

Support Services

Trolley collection and retrieval services

Trolley maintenance services

Retail cleaning and maintenance services

Store logistics and transport services

Product Supply Services

Trolley sales

Company Details

* Company Name
* Company Contact
* Phone
Mobile
* Address
* Suburb
* State
* Postcode
Email
Date of Incorporation
Type of work conducted - Services and/or products offered
Coverage
States that your company covers
Structure of the organisation - Company, Sole trader, Partnership

Insurance Details

Do you have public liability insurance?

Yes

No

Policy Number

Do you have Workers Compensation Cover?

Yes

No

Policy Number

Do you have Professional Indemnity Insurance?

Yes

No

Safety Details

Do you have an OHS Policy in place?

Yes

No

Plant and Equipment

Please list your plant and equipment
Other Comments
Why have you decided to apply to work with ESS?

Thank you for your application

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