Application Form

NAME:*

SS# (if a Sole Proprietor):

BUSINESS NAME: *

EIN# (if a Corp/LLC):

ADDRESS:*

Insured (Y/N): *

Yes

No

Workers Comp (Y/N): *

Yes

No

24 H PERSON OF CONTACT AND PHONE: *

# of miles daily travel coverage:

BUSINESS EXPERIENCE:

Years in janitorial business: *

Number of employees: *

Provide Training program? (Y/N): *

Yes

No

Areas that you presently service (provinces/estates you cover): *

Name 3 references:

Company:

Contact:

Phone:

Company:

Contact:

Phone:

Company:

Contact:

Phone:

Have you subcontracted before? (Y/N):*

Yes

No

If yes, WHERE?

Tell us about your company (mark all that applies):

MACHINERY YOU CAN USE:

Floor Stripping Machine

Back Pack Vacuum

Auto Scrubber

Burnisher

Industrial Vacuum

Extractor

Carpet Shampoo Machine

YES/NO

OWN/RENT

SERVICES YOU CAN PROVIDE:

Please list any extra services you provide:

I certify that the above is true and correct to the best of my knowledge. The undersigned authorizes UBMS LLC. to make inquiries they consider necessary and appropriate concerning the above, including providing information about this transaction to credit reporting agencies.

Signature:*

Date:

This field should be left blank

Subcontractor Job Application

Application Form

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