TERUMO CARDIOVASCULAR SYSTEMS TITLE: Supplier Questionnaire Request ************************************************************************************* Company Name Name Supplier Contact: Company Website Email Phone Manufacturing/ Other facilities used by Terumo CVS? Remit Service Location (e.g. shipping) N/A Yes No Street Address Street Address If yes, please explain: City, State City, State Postal Code, Country Postal Code, Country Phone Phone How long in operation? Total number of employees at this site? Number in Quality: Manufacturing: Engineering: Temporary: Is your company registered with the FDA? FDA registration number, if applicable Percentage of customers in medical device industry? Size of Facility in square feet: Scope and overall summary of primary products / Does your company have a quality policy? services provided at this facility: Yes No If yes, please state or attach policy Does your company rely on third party Yes No N/A If yes, please explain: contract manufacturers? Does your company provide sterilization Yes No N/A If yes, please explain: services or contract a 3rd sterilization service provider? Does your company rely on third party Yes No N/A If yes, please explain: design/engineering providers? Does your facility have a clean room with Yes No N/A If yes, please explain: established environmental controls?
TERUMO CARDIOVASCULAR SYSTEMS TITLE: Supplier Questionnaire Request ************************************************************************************* Company Name Supplier Contact: Name Company Website Email Phone Manufacturing/ Service Location Other facilities used by Terumo CVS? (e.g. shipping) Remit N/A Street Address City, State Postal Code, Country Phone Yes No If yes, please explain: Street Address City, State Postal Code, Country Phone How long in operation? Total number of employees at this site? Number in Quality: Manufacturing: Engineering: Temporary: Is your company registered with the FDA? FDA registration number, if applicable Percentage of customers in medical device industry? Size of Facility in square feet: Scope and overall summary of primary products / services provided at this facility: Does your company have a quality policy? Yes No If yes, please state or attach policy Does your company rely on third party contract manufacturers? Yes No N/A If yes, please explain: Does your company provide sterilization services or contract a 3rd sterilization service provider? Yes No N/A If yes, please explain: Does your company rely on third party design/engineering providers? Yes No N/A If yes, please explain: Does your facility have a clean room with established environmental controls? Yes No N/A If yes, please explain: