Supplier Qualitative Questionnaire

With Haile Gold Mine being the largest gold mine east of the Mississippi River, it has a demand for large amounts of materials per year. Some of the common materials are: Industrial Equipment, Piping, Heavy Equipment Supplies, Personal Protective Equipment (PPE), Motors, Pumps, etc.

If you feel your business could potentially supply Haile with product, please fill out the survey below, with your estimated monthly supply capability. Once completed your submission will be emailed to Haile Gold Mine’s Senior Buyer. If they feel there is potential for both parties to undertake in business, they will contact you.

Company Details
Name of Company*
Company Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Office Telephone Number*
Office Email Address*
Company's Annual Revenue (USD)*
Name(s) of other group companies, parent company and/or subsidiaries (if applicable)
Brief description of the goods/service you can provide
Key Contact Person Details
Name of Key Contact Person*
First Last
Title
Contact Number (Direct)
Contact Number (Mobile)
Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email Address*
Capability & Coverage
Please provide details on your company's capacity to provide service to the HGM Site
What is the number of full-time and part-time employees on company's payroll
What additional value added services does your company provide to differentiate from your competitors. (e.g. specialist technical support, inventory management, infrastructure etc.)
Conflict of Interest
Do you have any potential interests, relationships or clients which may or do give rise to a conflict of interest?
- Yes
Note: A conflict of interest is defined as an individual / organization having multiple interests (e.g. investment in the company, family/friend in the company), which may cause undue influence on the relationship between your company and Haile Gold Mine
If YES, please provide details of the area of expertise in which that conflict or potential conflict does or may arise and details of any strategy for preventing conflicts of interest.
References
Company Name
Contact Name
First Last
Title
Phone Number
Email Address
Company Name 2
Contact Name 2
First Last
Contact Title 2
Contact Phone Number 2
Contact Email 2

Supplier Qualitative Questionnaire

Company Details

Key Contact Person Details

Capability & Coverage

Conflict of Interest

References