Become a Preferred
Field Service Vendor

Join our network of trusted vendors and receive consistent work orders in your service areas. Reliable repairs, done with care.

VENDOR APPLICATION

Please complete all fields below. All information will be kept confidential.

COMPANY INFORMATION

Legal Business Name *

DBA / Trade Name

Business Type *

EIN / Tax ID Number *

Business Phone Number *

Business Email Address *

Website (If Any)

Year Established *

Number of Employees *

BUSINESS ADDRESS

Street Address *

Suite / Unit / Apt (If Any)

City *

State *

ZIP Code *

Mailing address is different from business address

PRIMARY CONTACT INFORMATION

Full Name *

Title *

Phone Number *

Email Address *

INSURANCE INFORMATION

General Liability Carrier *

Policy Number *

Policy Effective Date *

Policy Expiration Date *

We can provide a Certificate of Insurance (COI) upon request

SERVICE AREAS

Select the states and/or regions you provide services in (we cover all 50 states) *

Nationwide (All 50 States)

Florida (FL)

Southeast Region

Northeast Region

Midwest Region

West / Southwest

Specific States (list below)

ADDITIONAL INFORMATION

Briefly describe the services your company provides *

Any additional information you would like to share?

AGREEMENT

I certify that the information provided is true and accurate. I agree to abide by the terms and requirements set forth by Rebeka's Elite Preservation.

Become a PreferredField Service Vendor

VENDOR APPLICATION

Become a Preferred
Field Service Vendor