Online Form - Supplier Registration of Interest

Name of organisation *

ABN or ACN *

Phone number *

Email *

Name of primary contact person (first and last) *

Title or official position held *

Head office location

Street Address:

City:

State:

Post Code:

Country:

Organisation snapshot including a brief history *

Please identify which areas of interest or industry you are in. *

Is your business registered on either the Aboriginal Business Directory Western Australia issued by the Small Business Development Corporation and/or registered with the Australian Indigenous Minority Supplier Office Limited (trading as Supply Nation)? *

yes
no

Is your business a minimum of 50% owned by a person of Aboriginal or Torres Strait Island descent? *

yes
no

Is your business an entity registered as an Australian Disability Enterprise (ADE) on the Australian Business Register? *

yes
no

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