Business Supplier Survey

Business Supplier Survey and Supplier Agreement

Please complete this Business Supplier Survey in full. The information provided will be used to evaluate the supplier for potential procurement, contracting, and compliance purposes. Completion of this form does not by itself create a purchase order or contract unless both parties subsequently execute a separate agreement incorporating these terms.

Whereas

WHEREAS Supplier Name: is engaged in the business of providing goods and services and represents that it has the capacity and qualifications to supply the goods and services described in this document.

WHEREAS Company Name: seeks to evaluate and, where appropriate, establish purchasing relationships with qualified suppliers and requires information concerning supplier capabilities, compliance, and terms.

NOW, THEREFORE, the parties agree that the Supplier represents and warrants the accuracy of the information supplied in this survey and that such information may be relied upon by the Company in procurement and compliance decisions. The parties further acknowledge that certain information provided may be subject to confidentiality and may be incorporated by reference into subsequent procurement agreements.

Supplier Contact & Company Information

Corporation    LLC    Partnership    Sole Proprietor    Other

Business Profile & Capabilities

ISO 9001    ISO 14001    AS9100    None   

Supply, Delivery & Pricing

Compliance, Insurance & References

Complies with applicable anti-bribery and anti-corruption laws    Not subject to trade sanctions or restricted party lists    Complies with applicable data protection and privacy laws

Scope of Work

Provide a concise description of the goods and/or services the Supplier is proposing to provide under any resulting purchase order or contract. Include deliverables, performance metrics, and any exclusionary items.

Payment Terms (Agreement)

Payment Amount (if fixed for initial engagement):

Late Payment Fee:

Term and Termination

Contract Start Date:    Contract End Date (if known):

Termination on Notice: Either party may terminate this supplier relationship for convenience upon days' prior written notice. Termination for cause shall be effective immediately following written notice where the non‑breaching party identifies a material breach that remains uncured following thirty (30) days' written notice.

Confidentiality

The Supplier acknowledges that the Company may disclose confidential and proprietary information. The Supplier shall maintain such information in confidence, not disclose it to third parties except as required by law, and use it only for the performance of obligations under any resulting purchase order or contract. The obligation of confidentiality shall survive termination of any subsequent agreement for a period of three (3) years unless otherwise agreed in writing.

I acknowledge and agree to the confidentiality obligations above:

Governing Law

This survey and any resulting contractual relationship shall be governed by and construed in accordance with the laws of the State of , without regard to its conflicts of law principles.

Entire Agreement

This Business Supplier Survey, together with any executed purchase orders or contracts that expressly incorporate it, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior negotiations, representations, or agreements, whether written or oral, relating to such subject matter. Any amendment must be in writing and signed by authorized representatives of both parties.

Certifications and Representations

The undersigned certifies under penalty of perjury that the information provided in this survey is true, accurate, and complete to the best of their knowledge; that the person signing is authorized to bind the Supplier; and that the Supplier will promptly notify the Company in writing of any material changes to the information supplied.

Supplier accepts the terms and representations set forth in this document:

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