Install Partner Questionaire * Contact information Contact Name Company Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address Phone Number * What is your 24 hour or emergency contact information? Name Email Address Phone Number * 1099 eligible? Yes No * Do you have branch offices? Yes No If yes, where? * Is your company unionized? Yes No * Is your company UL approved? Yes No * Have you had any OSHA violations in the last 5 years? Yes No If yes, please explain. * Total number of employees * Number of shop employees * Number of field employees * How many crews can be mobilized for program installs? * What is the square footage of your shop? * What distance are you willing to travel for an install? (in miles) * Do you recycle lamps, wire, and other recyclable materials after servicing or installing signs? Yes No * Are you a woman-owned or minority-owned business? Yes No * What is the maximum height of service? (in feet) * Do you employ one or more certified electricians? Yes No * Do you provide the following services? Yes No Installation of Building Signs Installation of Building Signs Yes Installation of Building Signs No Installation of Ground Signs Installation of Ground Signs Yes Installation of Ground Signs No Installation of Highway Signs Installation of Highway Signs Yes Installation of Highway Signs No Manufacture Manufacture Yes Manufacture No Maintenance & Repair Maintenance & Repair Yes Maintenance & Repair No Survey Survey Yes Survey No Post Installation Inspection Post Installation Inspection Yes Post Installation Inspection No Energy Audit Energy Audit Yes Energy Audit No Interior Lighting Install Interior Lighting Install Yes Interior Lighting Install No Exterior Lighting Install Exterior Lighting Install Yes Exterior Lighting Install No Digital Graphics Digital Graphics Yes Digital Graphics No Welding Welding Yes Welding No * Do you have the following insurance? < $500,000 $500,000 $1,000,000 $2,000,0000 > $2,000,000 None General Liability General Liability < $500,000 General Liability $500,000 General Liability $1,000,000 General Liability $2,000,0000 General Liability > $2,000,000 General Liability None Excess Liability Excess Liability < $500,000 Excess Liability $500,000 Excess Liability $1,000,000 Excess Liability $2,000,0000 Excess Liability > $2,000,000 Excess Liability None Auto Liability Auto Liability < $500,000 Auto Liability $500,000 Auto Liability $1,000,000 Auto Liability $2,000,0000 Auto Liability > $2,000,000 Auto Liability None Workers Compensation Workers Compensation < $500,000 Workers Compensation $500,000 Workers Compensation $1,000,000 Workers Compensation $2,000,0000 Workers Compensation > $2,000,000 Workers Compensation None * Please provide a reference: Name Company Email Address Phone Number * Accounting contact information Contact Name Email Address Phone Number * If you would like to be paid by ACH (instead of checks) please fill in the below: Routing Number Account Number * Colite's Terms of Payment are Net 60 days after successful completion of the project, submittal of your invoice, customer sign off form and proper completion photos. Do you agree to these terms? Yes No In order to finalize your vendor application, we need you to provide your Certificate of Insurance (COI) listing Colite as Additional Insured and W9 to installer@colite.comThank you! We look forward to working with you. Submit
