Vendor Application Form Complete this simple 3-step form to apply to be a BOSS Contractor! Step 1 of 3 33% Contractor ProfileCompany Name* DBA* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*After Hours PhoneFax800# (if applicable)Website Address (if applicable) President of Company* First Last Email* Registered Minority or Veteran owned?* Yes No Union Shop?* Yes No Primary Contact InformationPlease Confirm Agreement* I agree to the terms and conditions provided and I'm am an authorized representative of the company Is Primary Contact info same as Contractor Profile Information?* Yes No Contact Name First Last PhoneExt. Cell PhonePager Contact Email Billing Contact InformationIs Billing info same as Contractor Profile Information?* Yes No Name First Last PhoneExt. Email Company InformationPrimary Services Offered* HVAC Refrigeration Plumbing Electrical Fire Safety Carpentry Roofing Telecom Signage Elevator / Asc. Janitorial General Repair Flooring Locks & Doors Pest Control Other Please Specify Trade* Markets your company is geared towards* Commercial Industrial Residential List any special services (Duct Cleaning, Water Treatment, etc)*Zipcodes within which you service*Rates and ChargesTechnician Labor* Technician Overtime Rate* Helper Labor* Helper Overtime Rate* Do your labor rates differ for Contract and T/M?* Yes No Contract Rate* T/M Rate* Are there any Minimum 1st Hour charges?* Yes No Specify Charges* Are there any truck charges?* Yes No Specify Charges* Are there any travel charges?* Yes No Specify Charges* Material Mark-up (%)* Other Charges* Company InformationNumber of Technicians and Helpers your company employs* Do you subcontract to other companies?* Yes No Please Explain*Do you hold any state/ federal trade licenses?* Yes No List Licenses* What states are you registered to collect taxes in?Please use only 2 letter state abbreviation. To add more states, click on the "+" sign to the rightStateAuthorization # Are your employees equipped with smartphones and/or tablets?* Yes No Please Explain*What type of software system do you use for dispatching, invoicing, tracking, etc.?* Industry Standard Custom Type What Type of Software? What Platform? What type of Internet Access do you have?* Cable Modem DSL T1 I do not have internet access Are you able to digitally send pictures of job sites?* Yes No Are you able to digitally send scanned documents?* Yes No Trade Reference 1Company Name* Contact Person* Phone*Email* Trade Reference 2Company Name* Contact Person* Phone*Email* Trade Reference 3Company Name* Contact Person* Phone*Email* Insurance Certificate*BOSS Facility Services, Inc. requires that each sub-contractor maintain up to date Liability and Workers Compensation Insurance Certificates, listing BOSS Facility Services, Inc. as additionally insured. Please include a copy of your Insurance Certificate. Drop files here or Select files Max. file size: 256 MB. Δ
