Imtech Inviron Supplier Application Form
Company Name______
Please complete the information in the shaded areas of the form below, and please ensure that you include all of the required enclosures.
Evaluation Reference number: / Form setup date:
Supplier / Local Office
(for returning this form)
Engineer
QSHE Advisor
1. General Company Information
1.1 Company Name and Address
Year Established
Company Name
Address / Tel No
Fax No
Contact name
Contact email
Postcode
1.2 Status of Company
Public, private etc.
Company Registration Number
VAT Registration Number
Are you a Sole Trader?
If Yes, please note that Imtech Inviron expects all PPE/hand tools and H&S training to be supplied by you. If Imtech Inviron does provide any of this, a charge will be made against you.
1.3 Turnover
Please detail turnover for the past 3 years.
1.4 Geographical area of operation
What geographical areas of the UK are you able to cover, either by region, or by radius from your office?
1.4.1 Operations in other countries
Please list all other countries where business is conducted.
1.5 Number of Personnel Employed
Detail numbers in the various disciplines within the company.
1.6 Additional Details - General Conditions of Purchase
Bank Account Details
Payee Name / Sort Code
Bank Name / Account Number
Payment Terms, from receipt of invoice:
Payment Terms as originally advised
Insurance Certificates
Please confirm that you have the following, and that you have attached copies.
Employers Liability Insurance Certificate
Public and Product Liability Insurance
Professional Indemnity liability Insurance
Optional comments in respect of the above
1.8 Sub-contractors
Sub-contractors are requested to supply the following information. Failure to do so may result in rejection of application.
If you are exempt, please indicate here and attach copy of letter from HMRC or Association.
UTR (Unique Tax Reference) Number:
1.9 Declarations
Has the business / company or directors ever been declared bankrupt or applied for bankruptcy? /

Yes [ ] No [ ]

Are any of the directors, owners or employees either a government official or related to a government official that might cause a conflict of interest while working with Imtech Inviron (e.g. in letting contracts or permitting operation)? /

Yes [ ] No [ ]

Is the business / company or any director currently subject to an investigation, or been convicted, of any criminal offence relating to business practice? /

Yes [ ] No [ ]

Does the business / company provide anti-corruption and anti-bribery training to its employees and agents? /

Yes [ ] No [ ]

2 Details of Activities
Scope Of Supply
Please describe briefly ALL the products and services that you offer.
3 Supplier Management
3.1 Does your company operate an approved supplier’s list? /

Yes [ ] No [ ]

If yes, please provide a summary of your key suppliers / subcontractors.
(You can include an enclosure if you wish. If you do, please indicate here)
4 Major Customers
4.1 List major customers, recent projects completed & their approximate value.
4.2 Please supply two corporate references or addresses of two Major clients.
6 General Conditions of Purchase
(Note – section 5 for Subcontractors not applicable)
We request addition to the Imtech Inviron Limited Approved Supplier List and confirm our agreement to their Terms and Conditions.
Name / Date
Position / Completed by:
Additional comments
Please add any optional comments below in support of your application.

Appendix – Supply Manager Assessment

Please add this Supplier / Subcontractor to our Approved Supplier List, and add the following Supplier Codes:

(add up to 5 codes)

Additional comments by Supply Manager

Please add any optional comments below, including your name and date.

Comments by Supply Administrator

JD Edwards No:
Loaded By:
Date Loaded
Owned By: / SJC / Supplier Application Form / MF-316-1-3
Approved: / SJC / Date: Nov 2014 / Revision: P / No Pages: 4