New Vendor Intake Form

Company Info

Your company name

Your company website

Street address

Suite, building, unit etc

City

State

Zip

Your company phone number

Your company fax number

Primary contact first name

Primary contact last name

Primary contact cell phone

Primary contact email address

Capabilities

Your coverage area

No. Crews

No. Bucket Trucks

No. Ladder Trucks

No. Cranes

Additional equipment

Hourly rate for one man & a truck

Your liability insurance coverage —Please choose an option—$500,000 - $999,999$1,000,000 - $1,999,999$2,000,000 +

Services you provide

Additional documents (rate card | service area map | marketing material)