Vendor Application Form

If your organization would like to be considered as an active vendor for Vectra Field Services, please complete the following appliction.
Please note: Red fields are required.

Company Info


Application Type:	Inspection Property Preservation Inspection & Preservation
Company Name:*
Address 1:
Address 2:

Email:*
Office Phone*
Cell Phone:
Home Phone:
Fax:
Officers names:		Add More
Office management names:		Add More
How many office employees?
How many salaried crews?
How many subcontractors?
How long have you been in business?
Type of technology you run your business with?
Do you use Fieldcomm?	Yes No

Work Type & Experience

General contractor?

Yes No

Type of license held:

License #:

State Issued:

Average time to perform work:

How many orders per day can be completed?

Can you take and email photos of work performed?

Yes No

Check all work types you perform:

General Contractor
Re-Key
Trash Removal
Yard Service
Pool Service
Hazardous Material Removal
Mold Removal
Mold Inspection Services
Inspection Services - General
House Cleaning
Carpet Repair & Installation
Flooring/Tile, Repair & Installation
Paint
Drywall
Electrical

Plumbing
Roofing
Masonry/Concrete
Tree Service
Cabinetry
Window/Door Repair & Installation
Pest Control
Heating, Ventilation & Air Conditioning
Stucco Repair
Winterization
Other (provide list)

Insurance & Reference Info

Insurance company name :
Insurance company address1:
Insurance company address2:

Insurance agent name:
Agent phone:
Coverage amount (e.g., 1000000):
Insurance carrier name:
Policy ID:
Policy expiration date:
Type of policy GL/ E&O?
Auto insurance name:
Auto coverage amount (e.g., 1000000):
Reference #1 Name:
Reference #1 Phone:
Reference #2 Name:
Reference #2 Phone:

Acknowledgements & Uploads

Pending litigation?	Yes No
Criminal Record?	Yes No
Coverage Area:
You are welcome to provide documents listing your territory coverage, proof of insurance, and a completed W-9. Please use the browse button to upload documents:		Add More
Required: Do you acknowledge and understand that if you are retained by Vectra Field Services, you will work as an independent vendor?
Yes No
Note: Completion of this application shall not be construed as creating an employee/employer relationship between you, your company or your employees and Vectra Field Services, and its affiliates; that it is the intent of the parties that every vendor/contractor performing work for Vectra Field Services, be and remain an independent vendor/contractor and not employees of Vectra Field Services; and that no vendor has the right to receive work from Vectra Field Services; and that work shall be awarded based on performance which is determined on an individual basis.
Required: I certify that the information above is true and correct and acknowledge and understand the above paragraph.
Enter Security Code: