Thank you for your interest in partnering with The Dirt Guy. We are always looking for qualified and reliable subcontractors to collaborate on new and exciting projects. This application is designed to help us gather the necessary information to evaluate your company's qualifications, experience, and suitability for our needs. Please fill out the following form completely and accurately to be considered for future opportunities. We appreciate your time and look forward to reviewing your application

Lease Haulers/ Vendor Application Form

Company name

Owners First name

Last name

Phone

Address

Garage Location/ Area

EIN

DOT#

Years in business?

Number of units owned?

Available for night shifts?

Available for weekend shifts?

Do you have a Workers Compensation policy?

If Yes, Please upload a copy of your Workers Compensation policy document.

Do you have a Commercial Auto Insurance policy?

Please upload a Certificate of Insurance with the certificate holder listed as follows: The Dirt Guy 4081 Redan Rd, Stone Mountain, GA 30083

I certify that the information provided on this application is true, complete, and correct to the best of my knowledge". I understand that any false, misleading, or incomplete statement or omission in this application may result in rejection of my application.

Signature

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