Independent Contrator Application


CORPORATE NAME (IF APP)
BUSINESS OR DBA NAME  
PRINCIPLE FIRST NAME  
PRINCIPLE LAST NAME  
BUSINESS ADDRESS  
BUSINESS CITY  
BUSINESS STATE  
BUSINESS ZIP  
BUSINESS PHONE  
BUSINESS FAX
BUSINESS CELL PHONE
BUSINESS EMAIL ADDRESS
TYPE OF BUSINESS

FED. TAX ID
(OR SS# IF SOLE OR PARTNER)
 
# OF REGULAR EMPLOYEES
# OF SUB-CONTRACTORS
YEAR ESTABLISHED  


List Retailers, Distributors, Chain Stores, etc that you regularly work for, or have worked for.


1.
Name
# of Location
Weekly Job Count
State
City
Types of Window Covering
2.
3.


List cities, counties, and states in which you are licensed to work.


1.
City, Counties / State
Type of License
License No.
Expiration Date
2.
3.


Check the type of window coverings which you are proficient.







List any other areas of expertise:


Summary

I Certify that the above statements are true and accurate to the best of my knowledge, and that I have in good faith returned this application for the sole intent to engage business activities in conjunction with Smith & Noble.

Name

 
Title