Vendor Application.pdf

Vendor Application Form Contact Information: Business Name: Contact Person:

Alt. Contact Person

Address: City:

State:

Office Phone:

Zip: Fax:

Mobile Phone:

Email:

Services Performed (Check all that apply to your company): Inspection Services: Property Inspections

Commercial Inspections

Mobile Home Inspections

Interview Inspections

Merchant Site Inspections

Natural Disaster Inspections

BPO/Appraisals

Insurance Loss Inspections

Property Preservation Services: Lock Changes

Lawn Service

Repairs/Rehab

Boarding

Eviction

FHA Conveyance Work

Winterization

Pool Covering

Debris Removal

Roof Patching/Tarping

Discount Rate Given: ________% Number of years experience: _________ Insuance Coverage Insurance Company: Coverage Type:

Policy Expiration: General Liability

Worker's Compensation

Errors & Omissions

Other ___________________________

References: Name: Phone:

Contact Person: Years Employed:

Name: Phone:

Contact Person: Years Employed:

Name: Phone:

Services Provided:

Services Provided: Contact Person:

Years Employed:

Services Provided:

Signature Date *Please fax your completed application to (305) 232-4110 or email it to [email protected]. Be sure to include your coverage area with this application.*