Vendor Application

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

 
Company Name:
Other DBA's:
Website:
Name:
Title:
Address 1:
Address 2:  
City:
State:
Zip:
Business Phone:
Fax:
Cell Phone:
 
All Relevant Licenses:
(i.e., contractor, tradesman, etc.) 
Business License Type:
License / ID Number:
Years in Business:
 
Insurance Provider:
Insurance Agent:
Agent Contact Phone:
Insurance Type:
Insurance Coverage Amount:
Insurance Policy Number:

Experience (please check all that apply):

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)
 
List two previous customer references:
Reference #1 Name:
Reference #1 Phone:
Reference #2 Name:
Reference #2 Phone:
 
Pending Litigation? Yes No (if yes, please explain)

Criminal Record? Yes No (if yes, please explain)

Coverage Area:
(please list by County)
Do you acknowledge and understand that if you are retained by Pacific Preservation Services Inc., you will work as an independent vendor?   Yes No

Note: The completion of this application shall not be construed as creating an employee/employer relationship between you, your company or your employees and Pacific Preservation Services Inc., and its affiliates; that it is the intent of the parties that every vendor/contractor performing work for Pacific Preservation Services Inc., be and remain an independent vendor/contractor and not employees of Pacific Preservation Services Inc.; and that no vendor has the right to receive work from Pacific Preservation Services Inc.; and that work shall be awarded based on performance which is determined on an individual basis.

I certify that the information above is true and correct  and acknowledge and understand the above paragraph.
Enter Security Code:*