Preferred Vendor Application:

Company Name

Company's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Company's Phone Number:

(###)

###

####

Company's website:

http://

Hours of Operation:

Company's Tax ID #:

Needed for payment.

Name of Company's Insurance Provider

A Certificate of Insurance will need to be supplied naming: "Rencor Realty, LLC" as the Holder and both: "Rencor Realty, LLC" and (the property ownership entity) as additional insured.

Phone number for Company's Insurance Provider

(###)

###

####

Frequency & days of service for this property

Primary Contact Person

First Name

Last Name

Primary Contact Person's Title:

Email Address for Primary Contact Person

Preferred contact method:

Additional Contact Person (if applicable)

First Name

Last Name

Phone # for Additional Contact Person (if applicable)

(###)

###

####

Email for Additional Contact Person (if applicable)

Date your company could begin service

YYYY

Included any additional information Rencor may need: