Work With Us
Company Information
Legal Company Name:
*
Operating As:
Company Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company GST/HST #:
*
Select the service(s) your company can provide:
Landscaping
Snow Removal
Litter Removal
Other
Primary Contact Information
Primary Contract:
*
First Name
Last Name
Main Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Primary Email:
*
example@example.com
Secondary Contact Information
Secondary Contract:
First Name
Last Name
Secondary Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Email:
example@example.com
24/7 Emergency Contact
24/7 Operations Emergency Contract:
*
First Name
Last Name
24/7 Operations Emergency Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
24/7 Operations Emergency Email:
*
example@example.com
Compliance Certification
We require "Worx Holdings Ltd" to be named as Additionally Insured, as well as "Exterior Maintenance Services" described on all insurance certificates.
Does your company carry a valid Liability Insurance?
*
Yes
No
Is your company certified under your provincial Workers Compensation Program?
*
Yes
No
Please provide the account number listed on your companies Workers Compensation Certificate
*
Submit
Should be Empty: