Staco Systems

Supplier Survey and Questionnaire

Instructions for use:

Short Form Survey:

Completion required by all suppliers. Requests general information for the Staco Vendor database. Please
complete and return this form to requester via email immediately upon receipt in order to be added to or updated in
our database.

Long Form Questionnaire:

Completion required by suppliers not currently AS9100 or ISO 9000 certified. Survey will be utilized by Staco
Purchasing and Quality Departments to assess supplier compatibility with Staco. Please return to requester via
email no later than one week after receipt.

COF-MP-20091 Rev 1.0 QR-20248

Page 1 of 14
 SUPPLIER SURVEY – SHORT FORM
Assessment Type: New Supplier Incumbent Revalidation
Supplier’s Company Name: Primary Contact Name:
Phone:
Supplier’s Fax:
Address:
Email:
Remit To
(if different) Payment Terms:
Website
Fed Tax ID #: (please provide W9) Annual Sales (USD): $
Privately Owned Public Corporation Subsidiary of or AKA:
Minority Owned SDV Owned
Small Business
Women Owned Small Business
Supplier’s Services Facilities & Equipment
What Types of services are provided? (Check all that apply & explain if necessary) # of Employees Plant Size
Manufacturer Distributor Service
Detail: # Years in Business # of Locations

# of shifts

Describe Equipment or Attach List:

What % of your business is with the aerospace industry? What is your current manufacturing capacity (in percent)?
1-10 21-40 61-80 41-60 81-100
QUALITY SYSTEM – IF CERTIFIED, PLEASE ATTACH COPY OF CERT .
Certification Exp. Date Not Certified, please answer the following:

ISO 9001 YN
AS9100 AS9100 Compliant?
AS 9120 Quality Plan?
NADCAP Quality Policy?
Other Risk Management Program?
Document Retention?
FOD (Foreign Object Debris) Program?
Counterfeit Materials Avoidance Provide CofC (Certificate of Conformance/Compliance)?
Policy? Yes: No:
Conflict Minerals Policy? Are you willing to allow Staco representatives to visit/audit your
Yes: No: manufacturing site on an on-going basis? Yes No
KEY CONTACTS
Position Name, E-Mail and Phone#
President/GM:
Quality Rep.:
A/R
Name of person completing form and certifying accuracy: Date
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