Subcontractor Application Name First Name Middle Name Last Name Doing Business As Address City State - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Business/Cell Phone Alternate Phone Email Address Years In Trade Preferred Workroom Location Preferred Workroom Location Keyport, NJ Garfield, NJ Nesconset, NY Products Installed Carpet Vinyl Tile Laminate Gluedown Wood Naildown Wood Certifications CFI RIC1 CFI R2C2 Pergo Endorsed Armstrong Certified NWFA Certified Mohawk Certified Do you have General Liabilities insurance? Yes No Do you have Workers Compensation insurance? Yes No If you do not have one or either, are you willing to obtain? Yes No Are you licensed? If yes, please list licenses in Comments section below. Yes No Comments If you have any questions regarding the independent subcontractor process please email us at recruiting@jandsflooring.net Keyport, NJ 07735 Garfield, NJ 07026 NESCONSET, NY 11767 Call Us (732) 497-0757 EMAIL US jands@jandsflooring.net
