RetailClean Vendor

Cleaning Application

Company Information

Trade:

First Name:

Last Name:

Street Address:

City, State, Zip:

Phone Number:

Cell Phone Number:

Email Address:

Skills and Qualifications: Licenses, Skills, Training, Awards

References (Include Name, Years Known, Phone Number):

Services Provided:

Do you provide carpet cleaning? -- Yes No

If yes, what kind of machines do you use?

Do you use truckmount or portable units? Do you use both?:

How many gallons is the portable unit? Brand? Truck-Mount brand?:

Do you use a hot-water extraction method? -- Yes No

Do you use a Chem-Dry method? -- Yes No

Do you use a Bonnet cleaning only method? -- Yes No

Do you use a Hot-Water extraction with a combination of Bonnet? -- Yes No

Do you use a Foam extraction method? -- Yes No

Do you provide tile floor care? -- Yes No

Do you provide Wood floor care? -- Yes No

Do you provide window cleaning? -- Yes No

Do you provide janitorial services? -- Yes No

Do you provide handyman services? -- Yes No

Do you provide powerwashing services? -- Yes No

Do you provide carpet and tile installation? -- Yes No

OTHER

Service Area: -- Local Only 20-50 miles 50-75 miles 75-100 miles 100+ miles

Number of Employees: -- 0-5 6-10 11-15 16-20 21-50 50+

Years of Experience:

What other national companies have you worked for?:

Do you have General Liability Insurance? -- Yes No

Do you have Workmans Compensation on your Insurance Policy? -- Yes No

Other Services Provided/Comments: