Subcontractors - Neg Building Services Inc. Neg Building Services Inc.

Service Providers

If you are interested in becoming an NEG Service Provider, please complete the form below.Your information will then be submitted to our Operations Department for review.

Questions marked by * are required.

Company Name:*

Contact Person:*

Email Address:*

Physical Address:*

Billing Address:

City:*

State

County:

Zip Code:*

Phone Number:*

Cell Phone:

Fax Number:

Please specify your service coverage area:*

Are you a Union company?*

Yes
No

Are there additional fees for Same Day Emergency Service?*

Yes
No

If Yes, please specify below:

Do you add any miscellaneous fees to your invoices?*

Yes
No

If Yes, please explain:

Number of Techs:*

Number of Vehicles:*

Years in Business:

% of Commercial Work:

% of Residential Work:

Hours of Operation:*

Do you sub-contract any of your work?*

Yes
No

Do you provide 24-hour emergency service?*

Yes
No

Do you have a digital camera available?*

Yes
No

Please list each type of license you hold, along with the license numbers:

Tax ID Number:*

Example: 9XX70XXXX

Insurance: (Please select all that apply)*

USD $1 Million Liability Coverage
Workers Compensation Insurance

Hourly Rate:*

Two-Man Rate:*

O.T. Rate:*

Holiday Rate:*

Do you charge a fuel/trip charge:*

Yes
No

If yes, please specify your trip/fuel charges:

What are your payment terms?:*

Please select the services you provide (Select primary trades only):*

Please list any other services you provide:

Please list at least 3 client references:

Do you provide services for any other national / regional companies?*

Yes
No

If Yes, please list the companies below and the services you provide:

The following agreements are required in order to be considered:*

I certify that any client information obtained through NEG will be kept confidential and will be used only to better perform the services requested by NEG directly.
I certify that I will not solicit any work, etc from any NEG client.
I give NEG full permission to run a background check on my company and employees at any time if desired.
I certify that the rates that I have submitted are the best available through my company.
I certify that I have answered the above questions honestly and accurately to the best of my knowledge.

Name

This field is for validation purposes and should be left unchanged.