Contractor Information Form
First Name
*
Middle Name (put N/A if no middle name)
*
Last Name
*
Date of Birth
*
-
Month
-
Day
Year
Date
SSN
*
Company Representing (This should be the name of the Independent Contractor (Not 3 Day Blinds)
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Drivers License Number
*
State of Issuance
*
Have You Verified The Driver's License
*
Please Select
Yes
No
Contract Position Applying For
*
Has installer ever directly contracted with or installed on any account that installs for 3 Day Blinds or any subsidiary company? If yes, please provide details with dates/company name.
*
Has the installer been convicted of a crime?
*
Please Select
Yes
No
If you selected Yes please provide details of the conviction
Would the installer like to receive an email copy of your Background Check click YES
*
Please Select
Yes
Form Filled By (Form Must be Filled by Install Owner or Management
*
Please list the name of the individual, at your installation company that met with this person and verified they signed the background authorization and all documents verified (i.e. DL and SS cards) to verify this person’s identity (installation company is responsible for keeping that form on file, for access if requested by 3DB)
*
Name of Company Representative
Authority to Release Information
*
Please Select
Yes
Submit
Should be Empty: