Vendor / Sub Contractor Intake Form Company Name* Company Phone* Company Email* Company Address* DBA Business TypeSole ProprietorshipLLCCorporationPartnership Website TypeSubcontractorSupplierRentalsOther Primary Contact: Name* Primary Contact: TitleEx. CEO, CFO, COO, Owner, Admin, Sales Manager, etc. Primary Contact: Email* Primary: Phone* Trade/Profession Years in Business Licensed?YesNoN/A Workers Comp TypeStandard Workers CompTexas Non-SubscriberNot RequiredPendingExemption Insurance Company COI*Do you maintain a Certificate of InsuranceYesNo COI Expires W-9*Are you required to privide a W9? This will be verified.YesNo Safety: Contact Name Safety: Contact Phone Safety: Contact Email Authorized Signer: Name PhotosAny photos that represent your company's products or workmanship. Submit
