Supply Page Partner Application Form - CLOCS-A

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Home
About
CLOCS-A Standard
- Overview
- Bronze
- Silver
- Gold
Champions
Suppliers
Case Studies
Toolbox Talks
Resources
News
- Events
FAQs

Supply Page Partner Application Form

Please complete the form below and submit for approval. CLOCS-A will contact you via your nominated email address with further instructions.

"*" indicates required fields

Email

This field is for validation purposes and should be left unchanged.

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Company Details

Company Name*

Trading Name*

ABN No.

Website

Business Address*

Street Address Address Line 2 Suburb State / Province / Region ZIP / Postal Code Country

Postal Address*

Same as Business Address

Street Address

PO BOX

Address*

Street Address Address Line 2 Suburb State / Province / Region ZIP / Postal Code Country

Supply Page Partner Categories

Please select the Supplier Category you are applying for:*

Vehicle Safety Technology and Equipment

Logistics Management

Training Services

Other

Please provide details*

Please tick the Supplier Tier you are applying for (prices are in AUD and exclude GST):*

Supply Page Partner Tier 1 ($5,000)

Supply Page Partner Tier 2 ($2,500)

Supply Page Partner Tier 3 ($1,500)

Contact Person

Main Contact Person*

First Name Last Name

Position

Phone*

Email*

Enter Email Confirm Email

Contact Person No. 2

First Name Last Name

Position

Phone

Email

Contact Person No. 3

First Name Last Name

Position

Phone

Email

Quality Assurance Details

Name of Person responsible for Quality

Full Name

Position of Person responsible for Quality

Are you Certified to ISO 9001 standard?*

Yes

No

Name of Certification Body*

Certification Number*

Please list any other approvals held:

Please upload copies of certificates held

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 50 MB.

Environmental Management System (EMS) Details

Name of Person responsible for your EMS

Full Name

Position of the Person responsible for your EMS

Are you Certified to ISO 14001?*

Yes

No

Name of the Certification Body*

Certification Number*

Please list any other approvals held:

Please upload copies of your Environment Policy and/or your certification held*

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 50 MB.

Consent*

Agree to the CLOCS-A General Service Agreement

and Privacy Policy

Consent*

Agree to the CLOCS-A Memorandum of Understanding and Terms of Reference

The CLOCS-A project is funded by the National Heavy Vehicle Regulator’s Heavy Vehicle Safety Initiative, supported by the Federal Government.

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