Vendor Registration Form

Homeland Development Services LLC Vendor Registration

Complete form below to signup as a vendor.
Company & Contact Info
Organization/Business Name*
DBA (if any)
Contact Name*
Title *
E-mail*
Company Website
Phone Number (Main)*

Area CodePhone Number
Phone Number (Afterhours)*

Area CodePhone Number
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Vendor‑Specific Fields
Trade/Specialty*
Other Trade/Specialty
Service Area (regions/counties)*
Licensed?*

YesNo
Business License #*
Business License Expiration

MonthDayYear
Date
Insured?*

YesNo
Insurance Company*
Insurance Policy Limits*
general liability amount
Insurance Expiration Date *

MonthDayYear
Date
Preferred Payment Method
W‑9 form

Cancelof
Certificates of general liability and workers’ comp insurance

Cancelof
Trade/contractor licenses and business registration certificate

Cancelof
Signed Subcontractor Agreement and Terms & Conditions

Cancelof
Before you continue, please download and review the HDS Vendor Terms & Conditions and Subcontractor Agreement. These documents outline the independent‑contractor relationship, insurance and licensing requirements, non‑circumvention clause, payment terms and dispute resolution process. You can download the full packet [here] and save a signed copy for your records. By selecting “Yes” below, you confirm that you have read and agree to these terms.
“I acknowledge and accept the HDS Vendor Terms & Conditions.”

YesNo
I hereby affirm that all information provided above is accurate to the best of my knowledge and belief, and I understand that this information will be considered material in the evaluation of quotations, bids and proposals.
Date

MonthDayYear
Date
Company Representative Signature

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Homeland Development Services LLC Vendor Registration

Company & Contact Info

Vendor‑Specific Fields