Vendor Application Form

Company Name*
Company Contact First Name*
Company Contact Last Name*
Office Phone*
Cell Phone*
Best time to contact by phone*
Email*
Address 1*
Address 2
City*
Zip*
Country*
Please identify the City closest to your address*
Services Provided*
Do you offer weekend or emergency service?*
What is your weekend or emergency service phone number*
If applicable, please list the number of locations you manage.
Please provide your current insurance coverage limitations for:
Liability Insurance*
Worker's Compensation Insurance*
How did you hear about CleanNet Canada?*
Comments

Testimonials

The level of service, on-going support, and personal commitment CleanNet Canada(™)has given us over the years has made it possible for us to succeed beyond our expectations. They continue to answer our questions and deal appropriately with the countless issues of running our business. Quote Image