Become an Approved Supplier Form

First Name *

Last Name *

Phone number *

Contact email address *

Have you been in contact with an integratedliving staff member about becoming an approved supplier? *

Yes
No

Name of the staff member (optional)

Are you aware of any actual or potential conflict of interest between your organisation (including any of its employees, officers, or contractors) and integratedliving? *

Yes
No

Are you aware of any actual or potential conflict of interest between your organisation (including any of its employees, officers, or contractors) and any of our clients? *

Yes
No

Please provide details below, including the name(s) of any individuals concerned, and the type of relationship or interest, and how you would manage the conflict. *

Who do we contact if we are requesting a service or placing an order? *

Use the same details from above
New contact person

Contact person for services *

Phone number for services *

Email address for services *

Become an Approved Supplier Form

Contact Details