CrimeShield USA Affiliate Form

Please tell us about yourself and your company

CrimeShield USA has partnered with companies across the United States to deliver services to our clients no matter where they operate. We are always looking for new affiliates to help us and our clients achieve the ultimate goal of being protected no matter where they operate. If you would like to become an affiliate and help in the protection efforts of our clients then please fill out the form below to get started. Once the form has been filled out, our management team will review all of the information and someone will be in touch with you. Please make sure to fill out the form completely. All incomplete forms will not be processed and deliberated on. That in turn may delay any affiliation. If you have any questions regarding this form please send us an email at: partner@crimeshield-usa.com OR call us at: 1-800-381-1245.
Company Contact Name

First NameLast Name
Contact Title
Legal entity name of your company?
Company Name
Email
example@example.com
Phone Number

Area CodePhone Number
What state(s) do you operate in?
What service(s) do you offer?

Other
How is your company setup?
How many employees do you have?
How many years have you been in business?
Are you currently fully licensed to operate a company in your state(s)?
If applicable, can your company provide a copy of your officer's firearms certificates?
What are your current limits for General Liability Insurance?
Do you currently have an Umbrella Policy for more than $1,000,000?
If required, do you carry a workers compensation policy by your state for at least the minimum limits required by law?
Please tell us what type(s) of vehicles your auto insurance policy covers?
Are you or your insurance carrier able to name our company as ADDITIONAL INSURED with a WAIVER OF SUBROGATION for ALL POLICIES and present this to us on an official CERTIFICATE OF INSURANCE?
If we decide to take your company on as an affiliate, is your company willing and able to adhere to our time clock management methods as well as being able to keep accurate logs, reports and incident reports? Is your company also able and willing to send us all official logs, reports and incident reports?
BY SIGNING BELOW, I hereby certify that the information provided and submitted on this form is true and accurate to the best of my knowledge. I understand that subcontracting is STRICTLY PROHIBITED and will result in nonpayment of any services rendered. I understand that providing false,misleading or partial information will result in termination ofCrimeShield USA's affiliate program.I agree to have all required documents such as but not limited to: proof of general liability insurance,proof of workers compensation insurance, copy of business license,W-9 form, affiliate agreement and any other documents requested byCrimeShield USA signed and sent back to CrimeShield USA within 5business days or less.In conclusion I also understand that not having ALL REQUIRED DOCUMENTS sent back to CrimeShield USA may cause a delay in issuing payments.
Once CrimeShield USA has recieved this completed form a member of our management team will be in contact with you.

Thank you for your interest in being one of our affiliates. We look forward to working with you!
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Please tell us about yourself and your company