Chevron Supplier Questionnaire
Supply Chain Management
Supplier's responses will be treated as confidential, and Chevron will use the responses for the purpose of qualifying Supplier to
potentially perform services or deliver goods, including the conduct of due diligence for legal compliance purposes. Information
about individuals submitted by Supplier may be transferred by Chevron to countries outside its country of origin (including to the
United States and/or other countries which may not afford individuals equivalent rights and protections with regard to their
personal information as provided under the laws of the data’s country of origin) for processing by Chevron affiliates,
subcontractors, and agents related to Chevron’s review and use of the information for the above stated purposes. By providing
such information to Chevron, you represent that you are authorized to provide this information for its use by Chevron as described
above.
Chevron may verify the validity of the information as it deems necessary, and Supplier shall cooperate with Chevron in this regard.
SUPPLIER INFORMATION
Full Legal Name of Company that will be the party to the contract
("Supplier"). If English is not the native language, please provide
the Company Name in Local Language. *
Years as a Chevron supplier (provide details of scope of service(s)
or product(s), dates and location) *
Principal financial institution to be used for payment processing *
FINANCIAL INFORMATION
Provide your financial information for the last two (2) years.
Has your company ever been involved in any bankruptcy or
reorganization proceedings? If so, please provide details. *
If Supplier is a privately held entity (not a Public Company),
please attach a copy of the last two years of audited financial
statements. (If you have multiple documents, please attach one
zip file.) *
If above-requested financial statements are not available, please
provide the following summary financial information and specify
the currency to the right. *
Fiscal Years (Most recent year first) *
Total Sales Revenue *
Net Income *
Cash & Equivalents *
Total Current Assets *
Total Current Liabilities *
Intangible Assets *
Current Portion of Longterm Debt *
Longterm Debt *
Total Assets *
Total Liabilities *
Retained Earnings *
Cash Flow from Operations *
AFFIRMATION
First Name: *
Last Name: *
Title: *
Company: *
Signature: *
By providing my signature, I certify that I am the person identified above and the information provided in this form is accurate and
complete to the best of my knowledge.
