Vendor Registration

Fields Marked with "*"are required

Company and Address Information
Company Name:	*
President/Owner Name:	*
Primary Contact:	*
Street Address:	*
Street Address (Cont):
City:	*
State:	*
Zip Code:	*
Country:
Phone Numbers
Work Phone:	--*
FAX Number:	--
Home Phone:	--
Emergency Phone:	--
Cell/Mobile Phone:	--
Pager:	--
E-Mail Address:	*
Website Address:
Trade Information
Approx. Service Area in Miles:
	Trade Description	Hourly Rate
Trades You can Perform and Hourly Rates		$ (Eg., 45)
		$
		$
		$
		$
Additional Trade Notes
Insurance Information
Do You Have General Liability Insurance?                                  Note: Retail Handyman, Inc will need to be listed as Certificate Holder and Additional Insured	-- Please Select -- Yes No   *
Do You Have Workers Compensation Insurance?	-- Please Select -- Yes No   *
If No Workers Compensation Insurance Would You Be Willing To Sign A Waiver:	-- Please Select -- Yes No Not Applicable   *
Do You Have Automobile Insurance?	-- Please Select -- Yes No   *
Do you have or would you be willing to perform criminal background checks of all field service employees.	-- Please Select -- No Yes   *

     

If your goal is to provide timely, cost effective quality work.
You've come to the right place!!