First Name (required)

Last Name (required)

Position (required)

Company Name (required)

Trade (required)

Company Email (required)

Office Phone Number (required)

Street (required)

City (required)

State(required)

Zip (required)

Do you provide emergency service? (required)
YesNo
Emergency Service Phone Number (optional)

Dispatch Phone Number (optional)

On-Site Contact Name (optional)

On-Site Cell Number (optional)

Billing Department Phone Number (optional)

Dispatch Fee (required)

Emergency Rates (required)

Service Rates (required)

per hourper techbook pricing
Comments

The following paperwork is required for partnership:

• Completed W9

• Certificate of Insurance: View the Sample COI to review the SERVCON Service Contractor requirements listed in red.

1. SERVCON LLC 10000 Twin Lakes Parkway, Suite B Charlotte NC 28269 must be listed as a certificate holder

2. "SERVCON is listed as Additionally Insured" must be in the Description of Operations box unless a Blanket Endorsement policy is provided.

3. All General Liability limits must meet requirements on sample COI.

If there is a fee associated with being added as an additional insured please reach out to someone on our Service Team for assistance.

• Service Contractor Insurance Acknowledgement  (download, sign, and submit) 

Download Service Contractor Insurance Acknowledgement