COMMERCIAL-IN-CONFIDENCE ABN 65 281 415 387

(when completed)

Vendor Information Request

Privacy and Confidentiality:

The information in this document is classified 'commercial-in-confidence' and is subject to the privacy, security and
confidentiality laws of the Commonwealth. The information will only be used for the sole purpose of transacting business.

Payment Terms: CRS Australia payment terms are 30 days from the receipt of a correctly rendered invoice.

*Denotes required field

CRS Staff use only Ensure this section is completed.

*Requesting officer’s name       *Signature:

Payment Terms 30 Days Comments:     
Authorised by regional manager
(Applicable if there is any change in the payment terms, or if
vendor requested payment by cheque, or a change to their
bank account details)
RM name       Signature Date:      
Finance will notify the requesting officer, once the Phone:      
vendor has been created.
Email

*Vendor’s details have been      

checked.
I confirm they are accurate
*Officer’s Name *Officer’s Signature

VENDOR DETAILS (Please print clearly)

Vendor: X New Vendor Number:      

Existing (currently in Nexus)

Trading Name*: A-Grade Training Services

Street Address*: 51 – 53 Enkleman road Postcode*: 4207

Suburb*: Yatala State/Territory*: QLD

Postal Address*: 51 – 53 Enkleman road Postcode*: 4207

Suburb*: Yatala State/Territory*: QLD

Telephone No.*: 0422 145 823 Fax No.:

Business Email Address: agradets@bigpond.net.au

 It is important for the vendor to ensure the business name used on this form
matches the name in the ABN register (www.abr.gov.au). If it does not, please
ensure a copy of the vendor’s Business Certificate or an Invoice, is attached to
the form when it is being submitted to Vendor Creations.

GST AND FINANCIAL INSTITUTION DETAILS (Please print clearly)

ABN*: 48 143 271 523 GST Registered*: Yes

The Government is committed to e-commerce and the preferred payment method to vendors is
electronically through a financial institution. Please record your BSB and Account details below .

Account name A-Grade Training Services

Bank BSB Account number

(Must be 6 digits)
084120 (No more than 11 digits)
750706803

Name of institution NAB Branch Beenleigh

Please send remittance advice via (Residential Mail (Mailed remittances will arrive a few
businesses are recommended to receive post remittances) days after EFT deposit)

The Government encourages its Agencies to source a greater share of their purchases from small to
medium enterprises (defined as fewer than 200 staff). Agencies are required to report to Government
about their performance in this regard. In order to help us meet this commitment, it would be appreciated
if you would indicate the number of staff permanently employed by your organisation by ticking one of the
selections below.

1-4

Vendor’s Authorisation

Until further written notice, we hereby authorise CRS Australia to make payments for goods or services
provided by our company through the method of Direct Credit, into the above-specified bank account.

Name: Stuart Gluyas Signature:

Title: Director / Manager Date: 28/09/2010

(eg Director/Manager)

The Commonwealth disclaims all liability in respect of any loss, damage or liability incurred by any person
as a result of anything done by the Commonwealth due to the provision of incorrect information by the
vendor, its nominated financial institution, or any officers, employees, agents or sub-contractors of either of
those parties or arising from any negligent, wilful or unlawful act or omission by any person other than the
Commonwealth.
Please return completed form to the nearest CRS Australia Unit