Intake Form | R. Allen Co.

Intake Form

Legal Business Name*

DBA/Trade Name

Owner/Principal*

Primary Address*

City/State/Zip*

Website

Federal Tax I.D.

Phone*

Email*

General Liability*

Worker's Compensation*

Commercial Auto*

Umbrella/Excess Liability

Years in Business*

Full-time Employees*

Can you provide 3 sample projects? (can be uploaded separately)

Yes

No

Project #1

Project #2

Project #3

Litigation/Compliance History*

No outstanding litigation

No OSHA violations in past 3 years

No state licensing sanctions

Bonding Capacity*

Comments

This intake form is used solely to evaluate potential project alignment and facilitate introductions. Completion does not create any obligation or contractual relationship with R. Allen Co. By submitting this form, you acknowledge that the information provided is self-reported and authorize R. Allen Co. to share relevant portions of this information with building owners, managers, or project partners for the purpose of evaluating potential project fit. Information will be shared only for referral and qualification purposes.

I agree

Insurance Certificates (COI)
Trade Licenses
BPI / NABCEP / Manufacturer Certs
W-9
Sample Project Docs
Recent Project Photos (optional)

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