Quote Information Sheet (Main Location to be certified)

Company Name: / Date:
Street Address / City / State / Zip / Country
Phone: / Fax: / Company website:
Contact Name: (who do you want the quote to be sent to?) / Title:
Contact Address:(If different from above) Street Address / City / State / Zip / Country
Contact Phone/ Email / Office (Direct Line or Extension) / Mobile/Cell / Email Address
Please tell us a little more about your organization.
Management Rep (If different from contact) / Street Address / City / State / Zip / Country
Management Rep Phone/ Email / Office (Direct Line or Extension) / Mobile/Cell / Email Address
Number of Sites
(If more than 1 - See Page 2) / Number of Shifts
(please provide times) / Major Product Lines and/or Services (please check all that apply):
Mfg. Design Distribution Purchasing Calibration Post Delivery Service
Customer Furnished Product Other (please specify)
Total Number of Employees: / IAF/ SIC / EAC Code: / Short Statement regarding the nature of your business (desired scope of certification ):
Any Outsourced processes to be considered? / Additional information/services/requests:
We are NOT currently registered to a management standard:
Standard of Certification you are seeking at this time (please check all that apply):
ISO 9001 ISO 14001 OHSAS 18001 Other (please specify):
We ARE currently registered to a management standard:
Which standard are you currently registered to? ______
What is the expiration date on your current certificate: ____/____/______
(please provide a copy of your current certificate and last complete audit report dating back to the most recent certification or recertification audit)
What was the last date of your initial Certified audit: ____/____/______
Which surveillance audit scheme are you currently using? Semi-Annual Annual
When is the next scheduled activity with your current registrar? ______
Reason for Transfer of Certified (i.e. Financial): ______
Are you presently working with a consultant? YES NO If yes, please provide name: ______
What is the desired date of Certified/transfer? ______
How did you hear about CIC Management, LLC.? ______

v  This information sheet may assist CIC Management, LLC in defining the scope of certification and preparing a cost proposal.

v  The receipt of this Company Information Sheet does not acknowledge our acceptance and/or approval of any aspect of possible certification.

ADDITIONAL SITES TO BE CERTIFIED.

v  Please complete the following table identifying (if any) additional site(s) are to be included in the certification.

Facility Name / Address (Street, City, State, Zip) / Desired
Standard (s) / No. of Employees / Products & Services (Scope – i.e. mfg/design/HQ/sales) / No. of Shifts / Shift Times

There can be several approaches to multi-site Certified. Please choose the most desirable/applicable approach for your organization:

□  Stand alone location OR multiple locations in close proximity to one another, operating and addressing all requirements of the standard collectively and issued ONE CERTIFICATE

□  Corporate Certificate with all sites, regardless of proximity, are audited collectively and are under ONE CERTIFICATE

□  Progressive Certificate where each site is audited separately then added to the corporate certificate when registered as a scope expansion

Please tell us a little more about your other sites:

1.  If multiple sites (Corporate), are your level 1 and 2 manuals (documentation) the same for all sites? YES NO

2.  If multiple sites (Corporate), are management reviews, internal audits, corrective / Preventive actions, and customer complaints coordinated by the main location? YES NO

3.  What Justifiable exclusions will be taken by your organization?

______

4.  Do you have a “remote” support site where contract review, design, and/or purchasing are located? If so, please describe:

______

Thank you for your time to complete this form.

CIC may contact you for any additional clarification needed.

Please return the completed information sheet:

Email:

WEB: www.cic-us.com

Address: PO Box 1358, Salem, NH 03079

Direct Phone: (603) 479-9912

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