Vendor Application:

To become an No Extra Charge, Inc. vendor, you must first apply. Please fill out
the application form below and an No Extra Charge, Inc. representative will contact you.

Company:
Street Address:
Address Continued:
City:
State:
Zip:
Office # :
Alternative Phone #'s:
Fax # :
Contact Names:
Email Address:
Type of Work:
Areas Covered: (list by town of county)

Your References

Company Name:
Contact:
Phone #:
Fax #:

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Company Name:
Contact:
Phone #:
Fax #:

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Company Name:
Contact:
Phone #:
Fax #:

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Company Name:
Contact:
Phone #:
Fax #:

After-Hours Emergency Sign Up

After-Hours Contacts:
After-Hours Phone #'s:
Additional Phone#'s:

Tax Identification Requirements

Requirements:

• You will need to provide your taxpayer identification number if you are an incorporation or a partnership.

• You will need to provide your social security number and/.or federal ID number (if one has been issued) if you are a individual / sole proprietorship.

Failure to provide your taxpayer identification number and/or social security number will require us to withhold tax at a rate of 27% from payment for work completed.

Additional Information

Please fax the following to us at 440-720-0694.

• Certificate of insurance naming No Extra Charge, Inc. as additional insured
• Copy of your certificate for Working Compensation