subcontractor registration form Fields marked with an (*) are required. Complete form and submit below: Company Name * Federal Identification Number * Name First Name Last Name Email * Phone * (###) ### #### Business Phone (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Are your resources currently available? * Yes No If you answered "No" what date would they be available? MM DD YYYY Please list all equipment available: Services Provided Please check all that apply to your business: Household Hazardous Waste Removal Tree Trimming and Removal Stump Removal Project Staffing Recycling Site Management Debris Reduction Debris Collection Hauling Snow Removal Marine Debris Removal Emergency Road Clearance Sand Screening Permitted Solid Waste Facility Comments: Terms + Conditions * Conditions * Disclaimer: By providing the information requested to L3 Investments, LLC, you promise that all information you provide will be accurate, current and truthful to the best of your knowledge. You further agree and acknowledge that L3 Investments, LLC will be relying on the information, that L3 Investments, LLC has no obligation to retain you as a subcontractor and that L3 Investments, LLC reserves the sole and exclusive right to retain any subcontractor or no subcontractors at all for a particular project. TO KNOWINGLY INPUT FALSE INFORMATION, INCLUDING, BUT NOT LIMITED TO NAME, PHONE NUMBER, ADDRESS AND COMPANY DATA IS A VERY SERIOUS AND FRAUDULENT MATTER THAT COULD RESULT IN SIGNIFICANT COSTS AND DAMAGES, AS WELL AS LOSS OF TIME, EFFORT AND EXPENSE, AND ACCORDINGLY, IF YOU PROVIDE FALSE INFORMATION YOU WILL FULLY INDEMNIFY ASHBRITT AND BE LIABLE FOR ACTUAL DAMAGES, DIRECT, PUNITIVE AND CONSEQUENTIAL, AND ANY REGULATORY OR JUDICIAL FINES OR PENALTIES THAT MAY ARISE FROM SUCH MISLEADING, HARMFUL AND FRAUDULENT INFORMATION, PLUS REASONABLE LEGAL FEES, COST AND EXPENSES RELATING THERETO. I agree to the terms and conditions above I Agree Thank you!
