Contractor Information Submission

Complete the following:

Company / Name:

(for background check)
Contact Numbers:
, Fax:
Driver's License:

Business References:
1. Phone:
2. Phone:
3. Phone:

Insurance Carrier: Phone:

Zips or Counties Covered Indicate counties here so we have a record of area:

(attach .xls or .doc if needed):

Payments will be made based on 50% of the gross invoice to company unless otherwise noted or agree to in writing. All requirements for work completion must be met for payments to be made. See terms and conditions.
Above applicant agrees to allow Total Lender Services or its assigns to inquire to all known tracking entities regarding criminal, personal and professional background. This may include a credit check using Trans Union, Equifax or other credit reporting agency. Information will be kept confidential to company and or authorized insurance providers.

Contractor: Date:

Security code:

17711 E Strack Drive Spring, TX 77379 Tel: 281-257-0233 Fax: 281-257-0523