Date: (required)
Firm Name: (required)
Firm Address: (required)
Contacts: (required)
Phone: Fax: Mobile:
Years in business under this name: (required)
Sole PropPartnershipCorporation
Federal Tax ID #: (required)
Bank Affiliation: (required)
Bank Phone:
Name of bank contact person:
Bonding capacity: (Letter certified by your agent)
Insurance Carrier and coverage: (Have your insurance provider mail a Certificate of Insurance naming Kort Builders, Inc. as an "Additional Insured" to Kort Builders, Inc., 8709 Castle Park Drive, Indianapolis, IN 46256)
Average number of employees: (required) Field Office
Size of projects you are capable of performing: (required) Low: $ High: $
Project 1: Contact 1: Phone 1:
Project 2: Contact 2: Phone 2:
Project 3: Contact 3: Phone 3:
Project 4: Contact 4: Phone 4:
Vendor 1: Address 1: Phone 1:
Vendor 2: Address 2: Phone 2:
Vendor 3: Address 3: Phone 3:
Vendor 4: Address 4: Phone 4:
Name 1: Title 1: Phone 1:
Name 2: Title 2: Phone 2:
Name 3: Title 3: Phone 3:
Areas of Specializations: (required)
Minimum Trip Charge: (required) $
Basic Price Rates for Services (Approximations: /sq.ft., /unit, /If, /yds, etc)
Please provide a Description and Price on it's own line. Double space additional lines.
Submitted by:
Your Name (required)
Your Email (required)
Your Title (required)
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