New Supplier Application / Change of Supplier Details*
[*Delete that which is not applicable]
Professional Experience / Student Placement
(This form must be completed for all new suppliers prior to the supply of goods or services
ABN 51 818 692 256
PO Box 663 Ballarat, Victoria 3353
Section 1
[This section must be completed by Staff Member. Forms will not be processed if Section 1 is not completed]
Supplier requested by: Sharon Davis Position: Prof Exp Coordinator Portfolio/School/Section: Faculty Ed&Arts Campus: MTH
Date:
Click here to enter a date.
Phone: 5327 9042 Supplier: Click here to enter text. Products/Services: Professional Experience
Section 2 - Supplier Details [This application form should be sent to the supplier for completion of this section]
Trading Name: ___________________________________________
Entity Name:
___________________________________________
ABN Number: __________-____________-___________-_________
Please Note: If the ABN does not match the Trading Name or Entity Name on the ABR the ABN will be treated as invalid and tax withheld from any
payment
Purchase Order Delivery Address
Payment Details, if different [e Remittance Address]
Contact : ____________________ Position:______________________
Contact : ____________________ Position:_____________________
Address: ___________________________________________________
Address: _________________________________________________
Town/City ___________________ Postcode: _____________________
Town/City ___________________ Postcode: ____________________
State:________________________ Phone: _______________________
State:________________________ Phone: ______________________
Email: ____________________________________________________
Email: ____________________________________________________
Section 3 – Bank Details for EFT Payment [This section must be completed and signed by an authorised officer of the supplier.] Please Note:
EFT is the University of Ballarat preferred method of payment.
BSB No:
Signature:
_____________________________________
Account No:
Position:
_____________________________________
Account Name: __________________________________________
Date:
________/________/____________
Bank:
Remittance Advice – preferred delivery method
_________________________________________________
Branch: ________________________________________________
[Please tick]
Once completed please forward to the Staff member indicated at the top of this form.
Internal Use only [Financial Operations Section]
Account Number
Authorised by:
Date:
Authorised by: Manager, Financial Operations
Document Owner:
Page 1 of 2
Category Code
Category Code
Manager, Procurement
Entered by:
Please indicate the
reason for this
application
1.
2.
3.
4.
ADDITION
CHANGE
MAKE INACTIVE
REACTIVATE
Date:
Original Issue: 01/6/2001
Current Version: 30/11/2011
Review Date: 30/11/2014
Instructions for Completion of Supplier Application Form
Instructions to Federation University Staff:
Who should use this form?
Section 1: Federation University Staff - for all new and existing suppliers
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The heading of this form should be amended to reflect whether a new supplier account is being created or to
request amendment of an existing supplier’s details.
Please complete your contact details, this will allow for further follow up if required.
Include here the name that you know the supplier as and ensure that this is the supplier trading name. The trading
name should match the name provided by the supplier on their invoice .
If the name you provide differs from the supplier trading name you will be contacted to clarify the name to appear
within the University’s Finance System.
When you have completed this section please send to the supplier for completion of section 2 and 3.
Instructions to Federation University Supplier:
Why complete this form?
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This form provides the authority for you to be established as a supplier, payment will not occur without completion
of this form.
This form provides useful information to enable us to classify your business by the goods or services you supply
and assist University staff to make future purchase transactions with your business.
Accurate completion of this form will assist the University to provide timely payment of your account.
Section 2: Completion by Supplier
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Your Supplier Trading name should be entered here and as it appears on the Supplier invoice. A valid ABN must
be included on this form.
If your ABN is registered under a different name such as a Trust or Company you should also provide the Entity
Name that appears on the Australian Business Register. Note: By providing the ABN you are stating that you are
the legal holder of this ABN and are entitled to trade under this registration.
Please ensure all other contact details are correct. The address and contact details you provide under the
“Purchase Order Delivery Address” heading will be where we post /email our purchase order. To ensure payment
you must quote this purchase order number on your invoice.
If you require your cheque or remittance advice to be sent to a different address you should complete the relevant
details under the “Payment Details” heading.
Section 3: Completion by Supplier
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This section must be completed and signed by an authorised officer of the supplier.
EFT is the Federation University preferred method of payment. If you elect to use this method of payment please
complete the banking details below Section 3.
If you wish to receive your remittance advice by email, indicate by ticking the box provided in this section.
Important Information for all Suppliers
Payment Terms:
Fed Uni seek to pay suppliers’ invoices within 30 days. This is dependent on a match between Supplier’s invoice
and Fed Uni Buyers acknowledgement of goods being received.
In order to expedite the process it is the Supplier’s responsibility to:
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ensure a tax invoice is submitted to Fed Uni Finance Department within a day of goods delivery;
the invoice matches the order amount;
the invoice states a Fed Uni Purchase Order number.
Only official Fed Uni Purchase Orders are valid and liable for payment. Suppliers should not accept verbal
orders unless payment is being made by Federation Purchasing Card.