Vendor Information Request - MEB Management Services Inc.

MEB
VIP INFORMATION REQUEST

*All fields below are required except where indicated*

Date:

Full Company Name:

Company Address:

City:	State:	Zip Code:

License Number:

Company Phone:

Company Contact:

Contact Cell Phone:

(optional)

Company Fax:

(optional)

Company Email:

Years in Business:

Service Offered:

Prices/Charges:

Additional Charges:

Overtime Rates:

(Note: this form continues below)

MEB will be moving forward with a Compliance Depot for all of our Vendor Services. Should you become a MEB Very Important Provider "VIP", thank you in advance for your cooperation in this process. It is appreciated!

MEB
QUESTIONNAIRE

*All fields below are required*

Company Name:
What is your rebate policy or promotions?
How many employees do you have?
What other states are you in?
Do you currently have any relatives working at MEB? Yes No
Were you under another name previously? Yes No
How many communities are you able to serve?
What areas do you currently serve?
Are you an AMA member?	Yes No
Do you supply workman's compensation for all your employees? Yes No
Do you run criminal background checks on all your employees? Yes No
What insurance do you currently carry?
What warranties or work guarantees do you currently carry?
Do you have a trip charge?	Yes No
Do you charge for proposals?	Yes No

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