New Affiliate Installer Form
Full Name
*
First Name
Last Name
Business Name
*
Business name
Structure (LLC, INC, CO, Partnership or DBA)
General Liability Policy Company Name and Policy Number
If none put none
Workers Comp Policy Company Name and Policy Number
If sole proprietor or DBA put none
Contractor liscense numbers:
*
If more than one, seperate with a comma
How many members on your team?
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
SSN or EIN
SSN
EIN
SSN/EIN Number
What is your specialty or most profitable service? We will place you in our bidroom based on your selection(s) pick two.
Residential Interiors
Residential Exteriors
Residential Cabinets
Residential Floor Coatings
Commercial Interiors
Commercial Exteriors
New Build Interiors
Other
Please Specify
*
Tell us about your proudest projects:
What does painting mean to you?
Please upload a current W-9 and certificate of insurance with PAINTR LLC as the named insured.
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How did you hear about us?
*
Please Select
Referral
Call
Email
Google
Social Media
Other
Please give reference of any two people whom you feel could use this service:
Full Name
Address
Contact Number
1
2
Signature
*
*
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