2. OS New Partner Form

New Partner Form

We are so pumped to work with you!!! (3-10 min)
Is this New Partnership due to a Referral? If so, who?*
Partner Type (Select all that apply)*

PlumberMitigationRoofingHVACAdjusterInsurance AgencyInsurance BrokerMGAInsurance CarrierInvestorProperty ManagementAttorney3rd Party MarketingPartners PartnerOther
Partners Partner selection option above pertains to our PPP (Partners Partner Program), so if you have a killer rolodex, we offer 1% of all Gross Revenue from Partnerships you help us land for the life of that Partnership...

So if you know other plumbers, or you are an adjuster with a team, or you know mit companies that do not do repairs... think of us so we can all make some money and get people back in their homes faster and better. Just make sure they put your name as Referral when they are filling out this form.

If you want more info on our PPP:
PPP VIDEO LINK HERE (7-min)
National or Localized Partnership? (f Partnership is National, but you would prefer to implement via localized, we will have to do one of these forms per radius/location)*

NationalLocalized
Your Company Name (If individual with no company, give first and last)*
Company Name
Company Dispatch Email (IMPORTANT if company and not individual)
example@example.com
Company Dispatch Phone (IMPORTANT if company and not individual)
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging.
Person of Contact 1 First Last*

First NameLast Name
Person of Contact 1 Email*
example@example.com
Person of Contact 1 Phone*
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging.
Person of Contact 2 First Last

First NameLast Name
Person of Contact 2 Email
example@example.com
Person of Contact 2 Phone
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging.
Person of Contact 3 First Last

First NameLast Name
Person of Contact 3 Email
example@example.com
Person of Contact 3 Phone
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging.
Person of Contact 4 First Last

First NameLast Name
Person of Contact 4 Email
example@example.com
Person of Contact 4 Phone
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging.
Person of Contact 5 First Last

First NameLast Name
Person of Contact 5 Email
example@example.com
Person of Contact 5 Phone
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging.
Any other Names, Emails, and Phones we should know
Name(s), Email(s), Phone(s)
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Billing Address (if different or if same as one of the above, in street address, tell us if it is "company" or "mailing" for billing)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Portfolio / Website link / Referrals / Reviews
Years in Business
Years in Property Claims
DESIRED RADIUSES YOU WANT US TO COVER

This aspect is very important, so we can be sure to be bolstered in the areas you require, so we can fulfill our performance promises. Please abide by the requested format, which helps our systems operate smoothly.

1. If you need us to cover entire States, just list the States.

Format: State1, State2, State3
(Example: Oregon, Washington, California, New York, Florida, Texas)

2. If you need us to cover only certain Counties within States, list the States and their Counties.

Format: State1, State1County1, State1County2, State2, State2County1 (Example: Ie: Oregon, Jackson, Josephine, California, Ventura, Orange...)

3. If you need us to cover only certain Zips within Counties, list the zips

Format: 11111 11112 11113 11114 (zip space zip space zip)

Sorry we don't have a cool map you can select from yet.
Desired Radiuses you want us to cover*
Ie: Oregon, Jackson, Josephine, California, Ventura, Orange...
CLICK ME FOR COUNTIES MAP

CLICK ME FOR ZIP CODE MAP
Please describe the radius you want us to cover in plain english (ie: Oregon from Eugene to Portland about 50 miles off of I-5. Also do large projects in Bend. Washington we go into Vancouver metro.)*
Average amount of Projects per month as per given radiuses*
#
Average Gross Revenue per Project
$
Forecasted Claim Gross Revenue per month in radiuses given
$
% of Projects you would like us to cover in given radiuses
1-100%
When would you like us to start?*

MonthDayYear
Date
Are you looking to have us undertake more radiuses in the future?*

YesNo
Any other info you would like to disclose?
Upload any relevant documentation

Cancelof
Company Billing Email (If you are a partner type who cannot take payments, just input X@X.com since it is a required field)*
example@example.com
Business Bank (Bank info required to add you as a vendor for direct payments into your account. If you are a partner type who cannot take payments, just input X since it is a required field)*
ie: US Bank
Business Bank Account # (if you are a partner type who cannot take payments, just input X since it is a required field)*
8-12 digits
Business Bank Routing # (if you are a partner type who cannot take payments, just input X since it is a required field)*
9 digits
Terms if you are willing to do an Exclusive Referral Partnership (answer for Accept or Decline below):

Obsidian Solutions Holdings LLC (“Obsidian”)
and the undersigned (“Partner”)

Term: Three (3) years from the Effective Date, automatically renewing every three years unless either party provides written notice of non-renewal.

1. Purpose
This Agreement defines an exclusive working relationship where both parties mutually benefit from consistent, transparent referrals.
Partner keeps full control over the work they wish to perform or subcontract directly, while Obsidian handles everything outside that scope — ensuring no client is left without a solution and both parties share in the reward.

2. Exclusivity
Partner may freely take on or subcontract any work they choose within their own service offerings.
For opportunities outside their normal scope, capacity, or desired workload, Partner agrees to refer those projects exclusively to Obsidian for the duration of this Agreement.
Partner will not forward such opportunities to any other contractor, TPA, or restoration firm while this Agreement is active.
This arrangement applies only to property-related or insurance-driven work; it does not restrict Partner’s unrelated or private-pay business.

3. Compensation
Obsidian compensates Partner for referred projects that close, according to standard referral terms provided at onboarding or in writing per project type.
Payment is typically issued within fifteen (15) business days after project closeout and receipt of funds.
Additional bonuses or revenue-share structures may be extended on a case-by-case basis and confirmed in writing.

4. Mutual Protections
Reputation & Client Respect: Partner’s customers remain their own; Obsidian will never solicit or market competing services to them.
Transparency: Both parties maintain open communication to ensure clients receive seamless service.
Integrity: Each party represents the other honestly, focusing on efficiency, quality, and client satisfaction.

5. Confidentiality
All shared business, client, or pricing information remains confidential.
Neither party may share or use the other’s information outside this partnership without written consent.
This obligation survives termination.

6. Term & Termination
Term: One (1) year, automatically renewing unless either party provides thirty (30) days’ written notice to end.
Termination for Cause: Either party may terminate immediately for material breach or misconduct.
Completion of Active Work: Projects referred prior to termination will be completed under these same terms, with all referral fees honored.

7. Independent Relationship
This Agreement does not create an employer–employee, joint-venture, or agency relationship.
Each party operates independently and remains responsible for its own taxes, insurance, and personnel.

8. Governing Law
This Agreement shall be governed by and construed under the laws of the State of Oregon, and any disputes shall be resolved through binding arbitration in Jackson County, Oregon.

9. Digital Acceptance
By selecting “YES” on the form, Partner confirms understanding and acceptance of this Exclusive Partnership Agreement.
Electronic consent carries full legal effect under the U.S. E-SIGN Act and UETA.

Effective Date: (auto-filled with submission of this Form/Contract Section)
Decision:*

YES – I agree to the Exclusive Partnership Terms with Obsidian Solutions Holdings LLCNO – I decline participation
Signature confirming that all above is true information filled and signed by Owner / Authorized User*

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