Independent Contractor Sign-Up

First Name

Last Name

Are you an LLC?

If yes, what's the company name?

Phone

Address

Address Line 2

City

State

Zip

Do you have Insurance survey/inspection experience?

Residential (Exterior)?

Residential (Interior)?

Commercial?

Mortgage?

High Value?

Drive-by?

Wind-Mitigation?

Do you have General Liability?

Do you contract with multiple vendors?

Have you been convicted of a felony in past 7 years?

Do you have a PC?

Do you have high speed internet?

Do you have reliable transportation?

How did you find out about Insurance Risk Services?

What areas do you currently cover? Please specify counties and or cities.

General Comments