ESS Australia - General Contractor/Supplier Application Form

General Contractor/Supplier Application Form

* Required

Title

First Name *

Last Name *

Email Address *

Company Name *

Company Contact *

Phone *

Mobile

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)

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

Do you have an OHS Policy in place?
Yes
No

Please list your plant and equipment

Other comments

Why have you decided to apply to work with ESS?

Enter Word Verification in box below *

Thank you for your application.