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BelVan Preferred Vendor/Sub Trade Application Form
Company
*Company Name: *Phone:
*Address: Fax no.:
*City, Province: Postal Code:
*Contact Name: Phone:
Owner (if different from above):
Organization
*Sole Owner: Partnership: Corporation:
Partner's Name (if applicable): *Started in (mm/yyyy):
Company's Previous Name (if applicable):
Insurance
*WCB Registration No.: *Are you current? (Y/N):
*Liability Insurance Provider:
*Policy No.: *Coverage Amount $: *Expiry Date (mm/yyyy):
*Information
Services Products Special Equipment
1. 1. 1.
2. 2. 2.
3. 3. 3.
4. 4. 4.
5. 5. 5.
General Contractor References
Company Name Contact Name Phone
*1.
*2.
*3.
Supplier References
Company Name Contact Name Phone
*1.
*2.
*3.