e&s Customer Qualification Form
Thankyou for your interest in allowing E&S to be a preferred supplier to your business. To assist with our customer qualification process, please fill in our e&s Customer Qualification Form as accurately as possible. This process helps us to understand your business and align you with the right specialist team to provide you with a best-in-class experience. Once reviewed, one our expert team members will be in contact.
How did you hear of e&s?
*
e&s Website
e&s Showroom Referral
e&s Staff Member
Word of Mouth
TVC or Radio
Social Media
The Block
Has your business previously purchased from e&s?
*
Yes
No
Type of work Undertaken: (select the option that best fits your business)
*
Accurate Construction Services Member
Architect/Designer - Custom Homes
Architect/Designer - Multi Residential Projects
Builder - Aged Care
Builder - Insurance/Renovations
Builder - Multi-Residential Projects
Builder - New Homes (Custom Selections)
Builder - New Homes (Standard Inclusions)
Builder - New Homes (Standard Inclusions & Custom Selections)
Builder - Townhouses
Cabinet Maker/Joiner
Commercial Builder - Hospitals, Schools, Cafes etc
Developer - Aged Care
Developer - Multi Residential Projects
Developer - Townhouses
Plumber - Multi Residential Projects
Project Management Company - Multi Residential Projects
e&s Sales Consultant or Key Account Manager:
*
Please enter name or type N/A if unknown
COMPANY INFORMATION
Company Name:
*
Trading Name (if different):
Date business commenced:
*
-
Day
-
Month
Year
Date Picker Icon
ABN:
*
ACN:
Do you have a Registered Builders License?
*
Yes
No
Registered Builders License Number:
*
Business Address (Street or P.O Box):
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Director Name
*
First Name
Last Name
Director Phone Number
*
Please enter a valid phone number.
Director Email Address
*
example@example.com
Director Name (no 2) - if applicable
First Name
Last Name
Is there a Main Contact who is different to the Director?
*
Yes
No
Main Contact Name:
*
First Name
Last Name
Main Contact Phone Number:
*
Please enter a valid phone number.
Main Contact Email Address:
*
example@example.com
Your Company Website:
*
www.example.com (lower case required)
Your Company Email Address:
*
example@example.com
Annual Business Turnover $
Optional
No of Dwellings or Units Constructed Per Annum (approx):
*
Please Select
1 - 4
5 - 10
10 - 20
20 - 30
30 - 50
50 - 75
75 - 100
100 - 150
150 - 200
200 - 300
300 - 400
400 - 500
500 +
Type of Purchases
*
Appliances
Bathroom Fixtures & Fittings
Whitegoods (ie washers, dryers & refrigeration)
Heating & Cooling
Outdoor Alfresco (ie BBQ's & BBQ Rangehoods)
Hot Water Systems
Expected Monthly Purchase Value with e&s
*
Please Select
$1,000 - $5,000
$5,000 - $10,000
$10,000 - $15,000
$15,000 - $20,000
$20,000 - $30,000
$30,000 - $50,000
$50,000 - $75,000
$75,000 - $100,000
$100,000 +
Preferred Brands
*
Please type to enter
Build Locations
*
Melbourne Metro Only
VIC Regional Only
Both Melbourne Metro & Regional VIC
Australian Capital Territory (and surrounding areas)
NSW Metro Only
NSW Regional
QLD Metro
QLD Regional
Hobart Metro
Tasmania Regional
If build locations are outside of Melb Metro, Hobart Metro or Canberra, please advise (and list) what towns or cities you build in?
Delivery Location Requirements
*
Please Select
Direct to Site
To Trade Partners (ie. Electrician, Plumber, Joiner)
Both Direct to Site and Trade Partners (ie. Electrician, Plumber, Joiner)
Delivery Day Frequency
*
Mon to Fri
Mon to Sat
Other
Do you have any job reference labelling requirements?
*
Yes
No
Maybe
Payment Terms Requesting
*
Please Select
Pre-Paid (COD)
30-day EOM Credit Trading Account NB: This request is subject to additional approval and trade history.
Accounts Email Address
*
If requesting a 30-day Credit Trading Account, please provide your accounts email address.
Purchasing
*
Home Owner
Builder
Architect/Designer
Additional Information
*
Please type to enter
Submit
Should be Empty: