Vendor Application – ServiceNational

Please complete all sections of this form. Incomplete submissions will not be processed.

All information provided will be kept confidential and used solely for vendor qualification purposes.

City *

Province / Territory *

Postal Code *

Contact Name *

Title

Phone Number *

Mobile Number

Check all trades and services your company is qualified to perform in a retail store environment:

Maximum Travel Radius (km)

Number of Service Technicians

Hourly Rate ($)
9am – 5pm

Emergency Rate ($)
5pm – 9am

Travel Rate ($)

Please attach copies of all current licences, insurance certificates, and certifications with this application.

Provincial Trade Licence #

Licence Province / Jurisdiction

Licence Type / Classification

Expiration Date

Certificate of Insurance (COI) naming our company as Additional Insured

Copy of Trade-Specific Licence(s) or Certification(s)

Proof of WSIB / CNESST / Workers' Compensation Coverage

Please provide three (3) professional references from current or recent clients:

Reference 1:

Company Name

Contact Name

Phone Number

Email Address

Reference 2:

Company Name

Contact Name

Phone Number

Email Address

Reference 3:

Company Name

Contact Name

Phone Number

Email Address

By signing below, I certify that all information provided in this application is true and accurate to the best of my knowledge. I understand that any false or misleading information may result in disqualification from vendor consideration.

I agree to comply with all applicable federal, provincial, and municipal regulations, and to maintain all required licences and insurance coverage at the minimum levels required.

I understand that submission of this application does not guarantee approval as a vendor, and that additional documentation or background checks may be required before final approval.

Printed Name *

Title *

Signature – Type Your Full Name *

Date *

I confirm that I am authorized to submit this application and certify that the information provided is accurate.

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