Contractor Information
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Company Name*
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| Owner |
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| Contact Person |
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| Address |
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| City/State |
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Phone #*
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| Cell Phone # |
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| Fax # |
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Email Address*
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Do you provide emergency service?*
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| If yes, emergency phone # |
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Do you have Liability Insurance?*
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| Coverage amount |
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Do you have Workers Compensation Insurance?*
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Do you have Workers Compensation State exempt form?*
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| Please indicate the services you can provide: |
Hot WaterExtraction RotaryShampoo Strip,Sealand Finish Machine Scrub and Buff(all hard surfaces) WindowCleaning Janitorial Additionalnot listed
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Please provide a list of equipment you currently use:*
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How many miles can you travel?*
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| Please list cities you can travel to: |
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