Service Provider Business Profile
Company Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Website {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
Business Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Person Responsible for Bidding {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Title {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Alt Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Business Registration {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
State of Incorporation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Years in Business {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
If Division/Subsidary Parent Company Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Parent Company Years in Business {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Address of Parent Company {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Equipment or other capabilities not listed above {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Geography Serviced - States {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Geography Serviced - Counties {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Geography Serviced - Zip Codes {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Employees - Supervisors {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
UntitledEmployees - Floor Technicians {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Employees - Cleaning professionals Full Time {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Employees - Cleaning professionals Part Time {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Federal EIN # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Unemployment Insurance Acct# {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Do you carry General Liability Insurance? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
General Liability Insurance Certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
General Liability Insurance Provider {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Insurance Company Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Policy Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Insurance Limit {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Insurance Exp Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Insurance Company Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Do you carry Workers Compensation Insurance? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Workers Compensation Insurance Certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
Workers Compensation Insurance Company {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Insurance Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Insurance Policy Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Insurance Limit {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Expiration Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Insurance Company Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Janitorial Bond Coverage Provider {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Janitorial Bond Coverage Amount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
To register the Service Provider/Vendor must fully complete this form and submit it to System4 Facility Services.
Approval or Rejection of Service Provider/Vendor Application
System4 reserves the right to approve or reject ANY application in its sole and absolute descretion. The Service Provider/Vendor will have no legal recourse against System4 for the rejection of the application.
Covanant Not to Compete and Non-solicitation
It is agreed that at no time during or for one year after the completion of any contract, billing or agreement with System4 will you engage in any business activity or solicitation which is competitive with System4 for work or contracts discussed, offered or dismissed by System4 including lost business.
Reasons for Rejection
Without limiting the right to reject any application for any reason whatsoever in the System4 absolute discretion, this application will be rejected if it is incomplete and or the applicant does not provide the required insurance and verifications as required by System4.
We declare that the above information is true, correct and complete and is given to induce System4 to accept my application as an authorized System4 Service Provider/ vendor.
Transaction Fee and Term Disclosure
System4 charges a 1% transaction fee for all billings on a monthly basis processed as a deduction from your monthly statement payment. System4 pays all service providers on a net60 term for services rendered to clients.
Name of Individual filling this form out {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Date of Application {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
I am authorized to submit this application and agree to the terms {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
I agree that by placing my name below it acts as my electronic signature for all purposes. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{{ Cognito.resources["powered-by-cognito"] }}