INDEPENDENT PARTNER AGREEMENT
CONTRACT FOR SERVICES
Partner Applicant Name
*
First Name
Last Name
Legal Business Name
This should match your 1099 tax document for payment
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (If this is the same, leave blank)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Partner Type
*
Please Select
Licensed Appraiser
Certified Residential Appraiser
Certified General Appraiser
Note: All Broker/Agents are eligible for inspections
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
E&O Insurance Declaration Page
*
Proof of coverage
E&O Claim Limit Per Occurance
*
Coverage per incident
E&O Expiration Date
*
Name Of The Insured Person
*
This is the provider who is insured
Have you ever had a license denied, revoked or suspended?
*
Please Select
Yes
No
Are You Interested In Desktop Valuation Assignments?
*
Yes
No
Unsure
FILLABLE ONLINE W9 FORM
(Or upload 2024 Version of the completed W9)
License (If Applicable)
*
Browse Files
Drag and drop files here
Choose a file
Email additional licenses to contactus@valligent
Cancel
of
Signed W9 (2024 Version Required) Or Use Link
Browse Files
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Choose a file
Upload or complete online form below (Only one is required)
Cancel
of
E&O Declarations Page Showing Coverage
*
Browse Files
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Choose a file
This is open for any additional documents
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of
Miscellaneous File Upload
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Choose a file
This is open for any additional documents
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of
State Licenses or certifications
*
Configurable list
*
Experience
*
Signature
*
Todays Date
*
Please verify that you are human
*
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Continue
Should be Empty: