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INDEPENDENT SERVICER/CONTRACTOR APPLICATION
Completing The ALN Independent Service Contractors Application

All the information requested must be completed and submitted to ALN for initial review.

Please review the following checklist of items that must be completed to insure your prompt consideration.

Checklist (required items) *

Completed Service Application

Copy Occupational license

Copy of current Insurance Certificate

W-9, Request for Taxpayer Identification Number and Certificate

Signature

Send By Mail

REQUIREMENTS

In order to keep you on our dispatch system, ALN must have on file at all times, a copy of your current certificate of insurance, occupational license. Please ask your insurance agent to list ALN as a certificate holder, with certificates to be sent to this address: When your current coverage expires, please be certain that ALN receives a copy of your new certificate of insurance and occupational license.

ALLIANCE LOCKSMITH

c/o INSURANCE CERTIFICATION DEPARTMENT

P.O. BOX 441003 KENNESAW, GA 30160

Please attach a copy of your certificate, occupational license to this page to be returned with your application.

INDEPENDENT SERVICE/CONTRACTOR APPLICATION

Date (Of This Application):
* Example :mm-dd-yyyy .
Legal Business Name:
*
Legal Business Address:
*
If outside US, list Country, Province or City:
*
Owner’s Name:
*
Manager’s Name:
*
Federal Tax ID Number:
*
What’s Your County, Province or City Sales Tax %:
*

Time Zone (Indicate Zone (s) Service:

*: Daylight Saving Time from March - October.
#: Daylight Saving Time from October - March.

Are you willing to accept Electronic Funds transfer if needed to be?

Yes No *

Is your Business Computerized:

Yes No *

Company EMAIL Address:

Business Mailing Address: (If different from above)

Do You Use A Live Answering Service: Yes No *

Do You Use Answering Machine Service: Yes No *

Would you like ALN. to send your works orders via: Fax E-mail Text Phone *

Would you consider changing your company's name to Alliance Locksmith : Yes No *

Phone Number and Hours Service Available (Indicate AM/PM Hours For Each Number Listed):
PHONE NUMBERS	MONDAY-FRIDAY	SATURDAY	SUNDAY	HOLIDAY
*	*	*	*	*
*	*	*	*	*
*	*	*	*	*

Do you perform Lockouts?	Yes No *	Do you perform Access Control Systems?	Yes No *
Do you service Safes?	Yes No *	Do you service Access Control Systems?	Yes No *
Do you perform Safe Openings?	Yes No *	Do you perform Motorcycles Keys?	Yes No *
Do you service Vaults?	Yes No *	Do you perform Boat Keys?	Yes No *
Do you perform Vaults openings?	Yes No *	Do you service Automotive Locks?	Yes No *
Do you install Alarm Systems?	Yes No *	Do you perform Automotive Lockout?	Yes No *
Do you service Alarm Systems?	Yes No *	Dose your company monitors alarms systems	Yes No *
Do you perform High Security Automotive Keys?	Yes No *	Do you service CCTV Systems?	Yes No *
Do you perform CCTV Systems?	Yes No *	Do you perform Airplane Keys?	Yes No *

List any other Qualification your company may have.

List your High Security Locks and keyway.

List the Counties, Province or City your Company Serves. (Let ALN know if this service is 24hr)

I hereby affirm that the information provided in this application is accurate and truthful.

By: *

Title:

Date: *
	Example :mm-dd-yyyy