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Subcontractors

Thank you for your Company's interest to contract with Regal Facility Management™. In order that Regal may further evaluate your Company, please complete the following:

DATE:

NAME OF COMPANY:

CONTACT NAME:

TELEPHONE
(include area code):

FAX
(include area code):

PAGER
(include area code):

MOBILE PHONE:
(include area code):

EMAIL:

ADDRESS:

CITY:

STATE:

ZIP CODE:

FOR CORPORATIONS, PLEASE ANSWER THE FOLLOWING:

1. Set forth the date of your business' incorporation and the state of it's incorporation.
DATE OF INCORPORATION:
STATE OF INCORPORATION:

2. What is your Corporation's Taxpayer Identity Number?

3. Is the corporation in good standing with the Secretary of State? Yes No
If no, please explain in complete detail.

4. Identify the president or chief operating officer of your Company.

FOR ALL BUSINESSES, PLEASE ANSWER THE FOLLOWING:

1. Identify which of the following is applicable to your business:
Corporation

Partnership

Limited Partnership

Sole Proprietorship
Other (please explain below)

2. How many employees does your company have?

3. How long has your Company been in business? (# of years)

4. Does your Company perform services for its own clients?

Yes No

5. Does your Company maintain worker's compensation insurance?

Yes No

6. Does your Company maintain general liability insurance?

Yes No

7. Do you have background checks done on your employees?

Yes No

8. Does your Company have any business relationships with Regal other than as an independent contractor?
Yes No

9. Have you ever been a Regal employee?

Yes No
If yes, state your dates of employment: From to

10. What is your Federal Tax Identity Number?

PLEASE CHECK THE EQUIPMENT YOU CURRENTLY OWN:

SCRUBBER	BUFFER	VACUUM	BUCKETS
MOPS	DUSTERS	BROOMS	CHEMICALS

Thank you for your interest in Regal Facility Management!