Car Audio Network Application
Does your company have general liability insurance?
*
Yes
No
Policy Expiration Date:
*
Does your company have garage keeper's insurance?
*
Yes
No
Policy Expiration Date:
*
Does your company have worker's compensation insurance?
*
Yes
No
Policy Expiration Date:
*
Back
Next
Company Information
Business Name:
*
Tax ID or EIN:
*
Email
*
example@example.com
Mobile Phone Number
*
Please enter a valid phone number.
Office Phone Number
*
Please enter a valid phone number.
Back
Next
Contact Information
Primary Contact Person
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Secondary Contact Person
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Back
Next
Does your company have general liability insurance?
*
Yes
No
Company Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Do we send payments to the same address?
Yes
No
Where Do We Send Payments?
Street Address
Street Address Line 2
City
State
Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Back
Next
Do you offer mobile service?
*
Yes
No
If yes, how many mobile road assist vehicles do you have?
Within what radius from your zip code do you offer mobile service?
Is your business insured to provide mobile services?
*
Yes
No
Other
Back
Next
Company Profile
How many years have you been installing?
How many installers do you have?
How many service bays do you have in your facility?
Please Select
1
2
3
4
5
6
7
8
9
10
11+
What other services do you provide? Please describe below.
Normal Business Hours
Monday Open
*
Monday Close
*
Tuesday Open
*
Tuesday Close
*
Wednesday Open
*
Wednesday Close
*
Thursday Open
*
Thursday Close
*
Friday Open
*
Friday Close
*
Saturday Open
*
Saturday Close
*
Sunday Open
*
Sunday Close
*
Back
Next
Background Check Compliance
Premiere Services requires all installers who are deployed to perform installations at residences or businesses to have up-to-date background checks maintained by their employer. If you have any questions regarding background check compliance please contact us directly at vendorapp@premiereservices.com.
Are you able to meet the background check requirement described above?
*
Yes
No
I'm not sure
If yes, please provide the name of the organization who performed these background checks:
Signature
*
Terms of Agreement
Premiere Services Requirements: Each installation provider is required to carry a current workman’s compensation and Liability insurance policy. Proof of insurance, naming Premiere Services as additionally insured and W-9 must be faxed to Premiere Services within 30 days at 800-810-5410 or emailed to vendorapp@premiereservices.com. Our Clients and their Customers must be able to contact you during regular business hours for service. Voice Mail or Cell Phone are acceptable provided calls are returned before the end of the following business day. You must warranty your installation labor for as long as the Customer owns the vehicle. You must notify the Customer of any additional parts and labor cost required before beginning the installation. Intentionally switching Customers to your products resulting in the return of our Vendor's merchandise is not permitted. You should make every effort to provide the installation quickly for the Customer. Schedule these installations the same as you would for any other Customer. Do not adopt a practice of only allowing these installations on certain days or extended waits relative to your other Customers. Premiere Services contractor understands that they are not an agent or representative of Premiere Services' and/or its Clients, and their relationship is solely with Premiere Services. Premiere Services, upon its sole discretion and at any time, has the right to assign work or terminate the application or agreement. Upon acceptance and approval you will be contacted regarding specific client service requirements and mutually agreed upon labor rate charges. Each physical on-site installation location is required to carry in addition, a current Garage Keepers insurance policy. Proof of insurance, naming Premiere Services as additionally insured and W-9 must be faxed to Premiere Services within 30 days at 800-810-5410 or emailed to vendorapp@premiereservices.com. A vehicle-condition inspection MUST be performed before and after the installation to ensure that the vehicle is returned to the Customer in the condition it was provided. Any damages that occur while the Customer's vehicle is in your custody are your responsibility. Items removed from the Customer's vehicle to facilitate installation of new equipment are the property of the Customer and must be returned to the Customer after the installation.
Have you read, understood and do you agree to the aforementioned Terms of Agreement?
Yes
No
Signature
*
Submit
Should be Empty: