Apply Today To Become An Installer | Affordable Bathrooms

Application

How did you hear about us?

Which city are you applying to work in?*

Personal Information

Applicant Name*

Name

Email*

Phone*

Date of Birth*

Personal Information Cont'd

Address*

Address Line 1 Address Line 2 City State ZIP Code

Employer Information

Who are you currently working for:*

I work for myself
I work for a company

Your Business or Employer Name*

Name of Business or Employer

Methods for receiving dispatch information

Check all that applies:

Email Dispatch
IPhone
Android

Check the installation services you can provide

In The Bathroom

Service Area*

I am willing to travel
I prefer a limited travel area

Affordable Bathrooms by Homeclub services clients in various cities and counties throughout your metro area. You must be willing to travel to these areas to do an assessment and provide installation services to our clients.

Electronic W-9

Request for Taxpayer Identification Number and Certification (W-9)
As you know, Homeclub, LLC. will need your W-9 information for federal tax reporting. Information sent from this website is encrypted and you can securely provide your W-9 electronically using the form below. However, if you are an individual (not a business) and prefer not to submit your SSN electronically, you can manually complete a W-9 Form and fax it to 888-394-4098. Click here for a W-9 Form

Tax Classification

Check Box For Tax Classification Info:*

Individual / Sole Proprietor
Corporation
Partnership
Other

Other Description

Part - I Taxpayer Identification Number (TIN)

If this is corporation, LLC or other business entity, please provide your federal Employer Identification Number (EIN). If this is an individual and not a business, please provide your Social Security Number (SSN).

Employee Identification Number (EIN)

Social Security Number (SSN)*

Part - II Certification

Under penalties of perjury, I certify that:

The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
I am not subject to backup withholding because : (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
I am a U.S. person (including a US resident alien).

Electronic Signature (type your name)*

Insurance

Homeclub requires the following license & insurance coverage:*

Valid Driver’s License
Auto Insurance: $100,000 / occurrence min
General Liability Insurance

Note: If you do not provide your own General Liability coverage within 6 months, insurance coverage of $1,000,000 will be provided to all Installers for a fee.

Auto Insurance Carrier Name*

Auto Insurance Carrier Phone*

Auto Certificate of Insurance

We must have a copy of your current auto certificate of insurance to maintain on file. If you have an electronic copy of your auto insurance certificate, please upload the file below:

Upload Certificate of Insurance

Drop files here or

Max. file size: 128 MB.

If you do not have an electronic copy, please fax a copy. Fax : 888-394-4098

Terms and Conditions of this Agreement

I have read this agreement carefully*

Agree

IN WITNESS WHERE OF, Consent is given by the applicant for a background check to be obtained by the Company. It is, however, understood that the applicant supplies this information contained herein to the best of his/her knowledge and ability and that the company relies on this fact in evaluating the applicant’s qualifications. This Agreement has been executed by the applicant as of the date accepted and executed by Homeclub as set forth below.