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Vendor Application
 
First Name :
Last Name :
Business Phone :
Mobile Phone :
Email Address :
Company Name :
Address  Line 1 :
Address Line 2 :
City :
State/Province :
ZIP/Postal Code :
What services do you specialize in :
Do you have experience working in the default service industry : Yes    No
If yes, briefly explain your experience:
Have you, or any of your employees ever been convicted of a felony : Yes    No
In the last 12 month has your company been sued : Yes    No
If yes, briefly explain:
Does your company have a D&B number : Yes    No
If yes, what is the number?
What is your Company Designation? :
Sole Proprietorship  DBA  LLC (LC, Ltd, Co.)
 General Partnership  LP  LLLP
 PC  PLLC  LLP
What type of insurance do you have? :
 Workers Comp  General Liability  Errors and Omissions
What states do you currently work in? Check all that apply :
Alabama Alaska Arizona Arkansas
California Colorado Connecticut Delaware
Florida Georgia Hawaii Idaho
Illinois Indiana Iowa Kansas
Kentucky Louisiana Maine Maryland
Massachusetts Michigan Minnesota Mississippi
Missouri Montana Nebraska Nevada
New Hampshire New Jersey New Mexico New York
North Carolina North Dakota Ohio Oklahoma
Oregon Pennsylvania Rhode Island South Carolina
South Dakota Tennessee Texas Utah
Vermont Virginia Washington West Virginia
Wisconsin Wyoming
Before submitting you must agree to the terms and conditions

Term and Conditions

All of the information provided above is true and accurate.  I understand that this is the first step of becoming a vendor with SLS and does not guarantee I will receive any work.  If I qualify to become a vendor with SLS, I understand that I will not be an employee of SLS, I will work solely as a (1099) sub contractor.  I am holding myself and my company out as a knowledgeable service provider in the default service industry and it is my responsibility to understand and abide by industry guidelines.

I AGREE    I DISAGREE
 
 
 
100 W. Airline Dr
Building A, Kenner, LA
504.667.5494
Website by Community Communications, Inc
    Residential Building Contractor
Expiration 4/24/2015
Licencse NO: 882120