CONTRACTOR FORM

Sub Contractor Application

Name of Business

Address of Business (City, State, Zip)

Phone of Business

Owner of Business or Contact Person

Owner of Business - Title

Owner of Business - Email

Owner of Business - Phone

Business Tax I.D. Number

Insurer

Policy Number

Please list some equipment that you have and what your company specailizes in such as, Floor Care, Plumbing, Painting, Auto Scrubber - high and low speeds, Propane buffer, Professional Painting equipment, etc:

Please list four (4) references, Name, Address, Phone Number and Contact Person:

I CERTIFY that the information given herein is true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for subcontractor employment as may be necessary for arriving at an employment decision. I understand that this application is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given on my application or interview may result in termination of any and all contracts.