Supplier Registration Form

Section 1: General Business Details

Type of entity (or name of sole trader)

Sole Trader (or partnership)

Public Company

Private Company

Joint Venture

Name of the company or entity

Trading Name (if different)

State of registration of company (if applicable)

ABN

ACN (if applicable)

Is the business registered under the GST Act?

Yes

Email*

Phone Number

Address of registered office (please include notes if your registered office is out of town (e.g. the location of your accountants) but your business is local)

Postal Address

Business Address

Preferred Address

Address of Registered Office

Postal Address

Business Address

Website Address

Nominated person for supply enquiries (full name, position and email)

Natural person authorised to represent the business (corporation only)

Section 2: Local Content Scores

Percentage of the company directors/owners that permanently reside in the Maranoa region?

100% (also relevant for sole traders)

75% - 99%

1 or more director/s or owner/s reside in the Maranoa region

No directors / owners reside in the Maranoa region

Percentage of your company employees that permanently reside in the Maranoa region?

Is your registered company address located in the Maranoa region?

Yes

Business premises (tick the one that best describes your situation)

Owned premises (the business/entity is a ratepayer in the Maranoa region - e.g. commercial or industrial ratepayer for a period of 2+ years)

Long term commercial lessee (2+ years)

Short term commercial lease (<2 years

including start-up businesses)

No presence in the Maranoa region (i.e. no office / shopfront)

*Has your business expanded beyond the borders of the Maranoa region?

Yes

*(i.e. was your business formed in the Maranoa region but has since commenced operations in other region/s? Businesses that have expanded from their base in the Maranoa are able to retain their '5 star local rating' if the company maintains a presence in the region (head office or home office) and the directors/owners still reside in the Maranoa).

*If other, please elaborate on the services your business can supply:

Section 3: Capability Database

*If other, please elaborate on the goods your business can supply:

Section 4: Consent

Disclosure of Commercial Information (Total Annual Payments)

Subject to local businesses’ participation in the My Maranoa Business program (completion of this supplier registration), Council will collate data on local spend with registered local (star rated) businesses for release through Council’s reporting processes (e.g. website, quarterly review, annual report), in order to promote Council’s local spend.

By completing this registration, the Respondent agrees that Council may release, disclose and publish in its annual report, and in other financial information Council produces or has produced on its behalf, the total annual payments made by Council to the Respondent, noting such information may become available to the public at large.

Nothing in this clause shall operate to prevent or limit Council’s rights to disclose this Information, or any part of it, nor will it fetter or restrict any disclosure required by law or under any Legislative Requirements, including without limitation as contemplated under the Right to Information Act 2009 (RTI Act) or under the Local Government Regulations 2012 (Qld) or as Council may otherwise determine in its absolute discretion.

Do you provide consent for Council to release the total annual payments made by Council to your business?

Yes

I consent to Maranoa Regional Council collecting and using my information for marketing purposes in accordance with their Privacy Policy.

We Respect Your Privacy

Maranoa Regional Council understands that your privacy is very important to you and wishes to preserve your right to control and protect that information. Under no circumstances will your name and address be given to any third party unless you have given us permission or we are required to by law.