Credit Application Onboarding Form

This form is for all material, crane, rental and miscellaneous operations (e.g., landscaping) and facility (e.g., electricians) vendors.

For all companies performing labor as Subcontractors please fill out the Subcontractor Form.

QualTek Requester Information

Requester First Name

Requester Last Name

Requester Email

Vendor Company Information

Company Name

Mailing Street

Mailing City

Mailing State

Mailing Zip Code

Country (if outside of US)

Tax ID Number (TIN/EIN)

Vendor Type

Doing work for which QualTek company?

Scope of Work (Please be specific with type of purchase or service requesting)

Please enter the name(s) of person(s) all notices should be mailed to

Diversity Business Classification

Select all that apply. May have to hold down CTRL key while selecting.

Need by Date

Vendor Contact Information

Vendor POC First Name

Vendor POC Last Name

Vendor POC Email Address

Vendor POC Phone Number

Vendor POC Fax Number

Payment Information

1099 Applicable

YesNo

One Check Per Invoice? (typically used by Government Agencies)

YesNo

Payment Terms

Credit Limit Requested?

Additional Information Needed

You will need to provide a full copy of your General Liability insurance policy from your broker and proof of Workers Compensation coverage in All States. Please attach these items below. Failure to attach these documents could delay the onboarding process. Thank you!

W-9 Form

Credit Application

Credit Application (2nd QualTek Company)

Credit Application (3rd QualTek Company)

COI (example is crane company)

COI (2nd QualTek Company)

COI (3rd QualTek company)

Other (e.g., email, quote)

Contact nmarciano@qualtekservices.com for help