MillTown Vendor Intake Form

MillTown Vendor Intake Form

Please complete this form to be considered for the MillTown Trusted Vendor Registry. Have your business details ready.
Business Name
Primary Contact Name
Job Title / Role
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Email Address
example@example.com
Business Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Service Category
If 'Other', please specify your service category
Brief Description of Services Offered
Coverage Area / Service Regions (e.g. “Kitchener-Waterloo, Cambridge, Guelph”)
Are you licensed?
License Number
Do you carry liability insurance?
Insurance Provider Name
Years in Business
Website URL
Facebook Page URL
Instagram Handle
Google Business Listing URL
Were you referred by a MillTown realtor?
If yes, please provide the realtor’s name
How did you hear about this vendor list?
I confirm that the information provided is accurate and consent to inclusion in the MillTown Property Group vendor referral list.
I agree to be contacted by MillTown realtors for referral purposes.
Should be Empty: