Preferred Vendors Form Step 1 of 6 16% Vendor Name(Required)Vendor Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Vendor Phone(Required)Vendor Email(Required) Point of contact Name(Required)Point of contact Phone(Required)Point of contact Email(Required) Company Tax ID(Required)Vendor Trade(Required)HVACPlumbingElectricalHandymanRemodelingOtherUntitled(Required)Coverage Area(s)(Required) Litchfield New Haven Fairfield Hartford Other (Multiple selection) Other Coverage Areas(Required) Pricing Model (Multiple selection)(Required) Hourly Rate Flat Rate Per Job estimates Do you have a Price list?(Required) Yes No Other Please attach Price list FileMax. file size: 300 MB.Price List DescriptionIf no price list, please give us a brief description of how much you charge for service calls Are you licensed in the State of CT?(Required) Yes No What type of insurance / Certification coverage does your company have? (Select all or one)(Required) General Liability Workers Comp E&O (Errors and Omissions) Auto Insurance EPA Certification (Drywall, Windows, anything around Lead) Select AllPlease confirm that you agree to use our vendor portal to submit:(Required) I agree to use our vendor portal to submit the following1. Schedule 2. Estimates (break out material labor) 3. Before and after pics 4. Invoice (break out material labor) 5. Communicate Work Order Status Consent(Required) Please read and sign our Preferred Vendor AgreementLAST STEP: Schedule a quick call with our Broker As a final step in our vendor onboarding process, please click on the link below to schedule time with our Broker: Click here to Schedule a quick call with our Broker to establish a mutual understanding of how our Preferred Vendor Program works.
