Vendor Profile Form - Please fill out this entire form and press submit when done or print it and fax it to us at 248.451.9664.
Company Name
Primary Contact
Company Address
Phone
Remit to Address (If different than above)
Federal Tax ID #
Services Provided
Years In Business
Service Area/Territory
How Long In Territory
Number of Service Vehicles
Number of Technicians
Best Time To Reach You	Daytimes Evenings
How May We Contact You?	Pager Number Cell Phone Fax Email Website
Do you provide after hours "Emergency" service?	Yes No
Normal Business Hours	to
Do you sub-contract work?	Yes No
If so, which type(s) of service?
Rate Structure
Hourly Rate
After Hours Hourly Rate
Material Markup	%
Travel Charge
Charge by actual time worked	Yes No
Helpers hourly rate
How many technicians do you send per truck, per job?
What is your guaranteed response time per service provided?
Provide 3 company references (retailers), with contact names and numbers
Business Name
Contact Name
Phone
Business Name
Contact Name
Phone
Business Name
Contact Name
Phone