| Name (*) |
Invalid Input |
|
| Company Name |
Invalid Input |
|
| Type of Business |
Invalid Input |
|
| Email |
Invalid Input |
|
| Phone |
Invalid Input |
|
| Fax |
Invalid Input |
|
| Website Address |
Invalid Input |
|
| Company Address |
Invalid Input |
|
| Date Business Commenced |
Invalid Input |
|
| Number of employees |
Invalid Input |
|
| Country |
Invalid Input |
|
| City |
Invalid Input |
|
| Options |
Invalid Input |
|
| Fed Tax ID |
Invalid Input |
|
| Release Licence no |
Invalid Input |
|
| Fed Tax Exempt No |
Invalid Input |
|
| Owner or Officer Name |
Invalid Input |
|
| Zip Code |
Invalid Input |
|
| Title |
Invalid Input |
|
| Home Address |
Invalid Input |
|
| Owner or officer City |
Invalid Input |
|
| Owner or officer Country |
Invalid Input |
|
| Zip Code |
Invalid Input |
|
| Owner or officer Zip Code |
Invalid Input |
|
| Owner or officer Phone |
Invalid Input |
|
| Owner or officer Fax |
Invalid Input |
|
| Owner or officer Email |
Invalid Input |
|
| Other Officers Name |
Invalid Input |
|
| Officers Titile |
Invalid Input |
|
| Previous Year Sales |
Invalid Input |
|
| Current Year Sales |
Invalid Input |
|
| Do You Intend to Perform Installation |
Invalid Input |
|
| Do You Provide Service and Repair |
Invalid Input |
|
| Total no of Installation Team Members |
Invalid Input |
|
| Experience Area |
Invalid Input |
|
| Licensed General Contractors on Staff |
Invalid Input |
|
| Name Address & Phone of Licensed Contractor |
Invalid Input |
|
| License No of Contractor |
Invalid Input |
|
| License Issuing State of Contractor |
Invalid Input |
|
| Licensed Electrician on Staff |
Invalid Input |
|
| Name Address & Phone of Licensed Electrician |
Invalid Input |
|
| License No of Electrician |
Invalid Input |
|
| License Issuing State of Electrician |
Invalid Input |
|
| Name Address & Phone of 3rd party Contractor |
Invalid Input |
|
| License No Type & Issuing Date |
Invalid Input |
|
| How long Have You Been Working With Contractor |
Invalid Input |
|
| Please Describe Previous Experience With Wind Solar or CoGenerator or Generators |
Invalid Input |
|
| Please Describe Previous Experience With Utility Related Work |
Invalid Input |
|
| Please Describe Previous Experience With Wind High Voltage Electrical Service |
Invalid Input |
|
| Please Describe Previous Experience With Wind High Voltage Electrical Service |
Invalid Input |
|
| Please List Products Certifications Currently Held |
Invalid Input |
|
| Do You Carry General Library Insurance |
Invalid Input |
|
| Policy No and Expiration Date |
Invalid Input |
|
| Insurance Carrier Name and Address |
Invalid Input |
|
| General Liability Limits |
Invalid Input |
|
| Propriety Damage Limits |
Invalid Input |
|
| Do you Carry Workers Compensation Insurance |
Invalid Input |
|
| Workers Comp Carrier Name |
Invalid Input |
|
| Are You Bondable |
Invalid Input |
|
| Where are Your Limits |
Invalid Input |
|
| Can You Secure a performance or Payment Bond |
Invalid Input |
|
| Name of Bonding Company if Currently Bonded |
Invalid Input |
|
| Bonding Limits |
Invalid Input |
|
| Customer Name |
Invalid Input |
|
| Contact Name |
Invalid Input |
|
| Customer Address |
Invalid Input |
|
| Customer Phone |
Invalid Input |
|
| Customer Fax |
Invalid Input |
|
| Customer Email |
Invalid Input |
|
| Customer Country and City |
Invalid Input |
|
| Customer Zip Code |
Invalid Input |
|
| No of Years |
Invalid Input |
|
| Vendors Name |
Invalid Input |
|
| Vendors Address |
Invalid Input |
|
| Vendor City & State or County |
Invalid Input |
|
| Vendor phone |
Invalid Input |
|
| Vendor Fax |
Invalid Input |
|
| Vendor Email |
Invalid Input |
|
| Finical Ref Name |
Invalid Input |
|
| Financial Contact Name |
Invalid Input |
|
| Financial Ref Address |
Invalid Input |
|
| Financial Ref City and State or County |
Invalid Input |
|
| Financial Ref Phone |
Invalid Input |
|
| Financial Ref Fax |
Invalid Input |
|
| Financial Ref Email |
Invalid Input |
|
| Financial Ref No of Years |
Invalid Input |
|
|
INSTRUCTIONS: Please complete this form in its entirety, including signature. Electronic signature is acceptable. Once
complete, email or fax to your GREEN ENERGY SOLUTIONS sales associate.
NOTE: This application is not to be construed as a binding contract between Applicant and GREEN ENERGY SOLUTIONS, and is merely
part of a screening and qualification process. Any misrepresentation, false statement or material omission by Applicant
shall entitle GREEN ENERGY SOLUTIONS, at its sole discretion, to reject and/or immediately rescind approval of this application, terminate
any existing relationship and avail itself to any and all legal and equitable remedies as may be available under applicable
law.
By submitting this application, you authorize GREEN ENERGY SOLUTIONS to make inquiries into the licensing information, experience
information, and business and trade references that you have supplied in this application.
|
|
|
|
|
|
Signatures |
|
| Applicant Signature and Date |
Invalid Input |
|
| Type or Print Name |
Invalid Input |
|
| Title of Applicant |
Invalid Input |
|
| Green Energy Solutions Signature and Date |
Invalid Input |
|
| Green Energy Solutions name or print Name |
Invalid Input |
|
| Title of Green Energy Solutions |
Invalid Input |
|
|
|
|
