Contractor Application Form Contractor Application Form Step 1 of 10 10% Section 1Personal InformationName(Required) First Last Address(Required) Street Address Address Line 2 Parish ZIP / Postal Code Phone(Required)Email(Required) Section 2Business InformationBusiness Name(Required) Business Business Address(Required) Street Address Address Line 2 Parish ZIP / Postal Code Business Phone(Required)Business Email(Required) Section 3Services OfferedServices(Required) General Contracting Electrical Plumbing HVAC Roofing Painting Carpentry Landscaping Other Please check the services you offer Section 4PersonnelList below onsite laborers / skilled laborers.List Add Remove Section 5Tax DetailsAre your accounts current with Government?Social Insurance(Required) Yes No Date Last Updated MM slash DD slash YYYY Social Insurance DocumentAccepted file types: pdf, jpg, png, xlsx, docx, Max. file size: 16 MB.Payroll Tax(Required) Yes No Date Last Updated MM slash DD slash YYYY Payroll Tax DocumentAccepted file types: pdf, jpg, png, xlsx, docx, Max. file size: 16 MB. Section 6Licensing and InsuranceContractor License Number:Issuing Authority:Expiration Date MM slash DD slash YYYY Insurance Provider:Policy Number:Coverage Amount:Do you have Liability Insurance? Yes No Do you have Workers' Compensation Insurance? Yes No Insurance Provider for Laborers:Laborers Policy Number:Laborers Coverage Amount: Section 7LegalHave you ever been involved in court proceedings or arbitration on any project?(Required) Yes No If yes, please explain:Have you ever declared liquidation or bankruptcy?(Required) Yes No If yes, please explain: Section 8Experience and ReferencesYears in Business:(Required)Number of Employees:(Required)Please provide three professional references:(Required) Add RemoveAdditional Information Drop files here or Select files Accepted file types: pdf, jpg, png, docx, xlsx, Max. file size: 16 MB, Max. files: 5. Please provide any additional information or documentation that may support your application (e.g., certifications, portfolios, etc.) Section 9Data Privacy ComplianceDo you agree that any information which is conveyed from BHC will be held in the strictest of confidentiality and will not be shared or used for any other purposes?(Required) Yes No By signing this application, you agree to comply with all data privacy guidelines. You must not use any tenant information for personal use or share it with unauthorized parties. Violation of this policy may result in termination of any agreements and potential legal action. Section 10SignatureCAPTCHAConsent(Required) I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any false statements or omissions may result in disqualification from consideration or termination of any agreement.
