Contractors Registration Form

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NAME OF COMPANY *

Contractor Type *

Corporation

Sole Proprietorship

Partnership

Other:

CONTRACTOR or REPRESENTATIVE *

BUSINESS ADDRESS: CITY: STATE: ZIP: *

BUSINESS TELEPHONE NUMBER: *

BUSINESS CELL *

ALTERNATIVE PHONE *

EMAIL ADDRESS: *

Date of Establishment *

YYYY

# of Employees *

Federal ID# *

State ID# *

'Better Business Bureau ID# *

Web Site *

Facebook Page *

Has your firm ever filed bankruptcy *

Yes

Are there any judgments against your firm *

Yes

Are there any claims against your firm *

Yes

Has your firm ever failed to complete a contract *

Yes

Insurance type *

Insurance carrier *

Insurance Contact email *

Insurance EMR# *

Reference #1 Name *

Reference #1 Phone number *

Reference #1 Email *

Reference #2 Name *

Reference #2 Phone number *

Reference #2 Email *

Reference #3 Name

Reference #3 Phone number

Reference #3 Emai

Service which you can provide to bid on *

Construction

Pool services

Pool supplies

Cleaning services

Excavation services

Plumping

Boiler services

Landscaping

Computer services

Electrical Services

HVAC Services

Winter Plowing Services

Other:

Submit

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