Vendor Registration Form

 
Thank you for your interest in the Schlitterbahn Vacation Village. Please fill out the form below to be added to the Schlitterbahn Vacation Village vendor database. *Required field.

Company Name*
Address*
City*
State*
Zip code*
Phone*
Fax*
Contact First Name*
Contact Last Name*
Email*
Cell Phone
Website
Is your company MBE WBE
MBE/WBE certified by
Is your company an LBE
Is address the Main Office  Regional Office Branch Office
Name of parent company
Address of parent company
City
State
Zip code
Items your company supplies*
Year company started*
Type of company Corp  Partnership  Proprietorship Sub S Corp
State of Incorporation
Date of Incorporation
State Sales Tax No.*

State Unemployment Insurance No.
Federal Tax ID No.*

How many people does your company presently employ
  Home Office
 Field Supervisory 
Trades People
List the geographical areas in which you work  
List three companies that you do business with
Name  
Address, City, State, Zip
Phone
Contact
Name
Address, City, State, Zip
Phone
Contact
Name
Address, City, State, Zip
Phone
Contact
Trade Association Memberships
List other key office personnel  
Name
Phone Number
Email Address
Name
Phone Number
Email Address

Commercial General Liability
Insurance Carrier
Policy Form
Policy No.
Policy Period From To
Occurrence Based
Claims Made
Any exclusions from  Standard CGL Policy Yes No
Limits  
General Aggregate Current Max Obtainable
Products-Comp/Op Agg Current Max Obtainable
Personal/Adv. Injury Current Max Obtainable
Each Occurrence Current Max Obtainable
Fire Damage (any one fire) Current Max Obtainable
Med. Exp (any one person Current Max Obtainable
Deductible
Per Project Limits Yes No

Worker's Compensation and Employer's Liability
Insurance Carrier
Policy Form
Policy No.
Policy Period From To
Limits
E.L. Each Accident
E.L. Disease-Policy Limit
E.L. Disease-Each Employee

Automobile Liability

  
Insurance Carrier
Policy Form
Policy No.
Policy Period From To
Combined Single Limit Current Max Obtainable
Bodily Injury (per person) Current Max Obtainable
Bodily Injury (per accident) Current Max Obtainable
Property Damage Current Max Obtainable
We have attempted to answer the above questions in a full and complete manner to assure that our answers are not in any respect misleading either by expressing ourselves in a misleading or ambiguous manner or omitting information
Form Completed by*
Title*