1 *Company Name:

2 *Address:

3 *City:

4 *State:

5 *Zip Code:

6 *Phone:

7 Fax:

8 Company Web Site:

9 *Services or Products Provided (check the category that best applies to your business type):
Repair & Maintenance, Facilities, Construction Service Provider
Architectural or Engineering
Equipment Supplier or Manufacturer
Food or Paper Products Supplier
Information Services
Marketing, Printer, or Designer
Other: 

10 Type a brief statement that describes more specifically the products or services your company provides:

11 Type the name of the Boston Market employee who directed you to complete this application, and/or will be your primary Boston Market Contact Person:

12 Check this box if you do NOT have a Boston Market Contact Person.
Do not have Boston Market Contact

13 Owners Name:

Owners Business Phone:

Owners Cell Phone:

Owners E-mail Address:

14 Account Managers Name (if other than owner):

Account Managers Business Phone:

Account Managers Cell:

Account Managers E-mail:

15 How many years has your company been in business?

16 Have you, your company or an affiliate ever previously performed work/services for Boston Market Corporation?
Yes No

If yes, under what name?

17 Provide a list of your previous or current restaurant company experience:

18 Provide contact information for 2-3 current clients whom we may contact as a reference. List company name, address, phone, contact person, and how long you or your company have done work with this company, years and/or months.

19 Does your company provide 24/7 service?
Yes No

If no, what are your company's regular hours of operation?

20 Does your company use an 800# to receive service calls?
Yes No N/A

If yes, what is the number?

If no, what is the best way to reach you or your company for service?

21 Does your company have the ability to receive a request for service via e-mail?
Yes No

If yes, what is the e-mail address?

22 What is your company's guaranteed response time for service requests?

23 List your company's general service area or states you are licensed to work in:

24 Are 3 years of audited financial statements available if requested?
Yes No

25 What is your company's annual sales volume dollars?

26 List your company's Workers Comp Insurance Coverage Amount:

27 List your company's Property Insurance Coverage Amount:

28 List your company's General Liability Insurance Coverage Amount:

29 Bonded Dollar Amount:

30 Do you or your company have any pending lawsuits?
Yes No

If yes, please provide a brief description:

31 Check any Associations your company belongs to:
SE
BBB
NSC
ACCA
Chamber
MAFSI
PHCC
CFESA
Other 

32 Hourly service rate:

33 Overtime Hourly Service Rate:

34 What days and hours are considered overtime:

35 Is there a trip charge?
Yes No N/A

If yes, what is the trip charge rate?

36 Is there a mileage charge?
Yes No N/A

If yes, what is the current mileage rate:

37 What is the discount percentage on parts?

38 Does your company perform warranty work?
Yes No N/A

39 Does your company perform preventative maintenance work?
Yes No N/A

40 Date current rates are effective through:

41 What is your company's Federal Tax ID #:

42 Select your company's type:
Sole Proprietor
Corporation
LLC
Partnership

43 Account Receiveable Contact Name:

AR Contact Phone:

AR Fax Number:

AR E-Mail Address:

44 *Check each box if your company has this capability:
Invoices show a complete company name and "remit to" address.
Invoices submitted must use a "nonrepeating" invoice numbering system.
Has capability to generate an electronic invoice.
None of the above

45 Does your company accept credit cards?
Yes No

If yes, list card types you accept:

46 Name of person completing this application:

47 Title of person completing this application:

48 Application Date: