Become an Installer ApplicationHow did you hear about us?Social MediaEmailWebsiteTrade ShowFlyerAdvertisementReferralClientHomeclub Contractor/EmployeeWhich city are you applying to work in?*Atlanta, GACharlotte, NCGreenville, SCRaleigh, NCBirmingham, ALCharleston, SCMemphis, TNJacksonville, FLPersonal InformationApplicant Name* Name Email* Phone*Date of Birth* Date Format: MM slash DD slash YYYY Personal Information Cont'dAddress* Address Line 1 Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer InformationWho are you currently working for:*I work for myselfI work for a companyYour Business or Employer Name* Name of Business or Employer Methods for receiving dispatch informationCheck all that applies: Email Dispatch IPhone Android Check the installation services you can provideIn The Bathroom Bathtub or Shower Basin Cabinets Carpentry/Framing Counter-top Door Door Lock Drain lines Drywall Electrical outlets Electrical wiring Exhaust Fan Faucet Flooring (Laminate Planks) Flooring (Tile) Hardware Light fixtures Light switch Painting Sink Toilet Trim/Baseboards Water Supply Lines Wall Tile Window Service Area*I am willing to travelI prefer a limited travel areaAffordable 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 ClassificationCheck Box For Tax Classification Info:*Individual / Sole ProprietorCorporationPartnershipOtherOther DescriptionPart - 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)*InsuranceHomeclub 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 InsuranceWe 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 If you do not have an electronic copy, please fax a copy. Fax : 888-394-4098 Terms and Conditions of this AgreementI 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. Electronic Signature (type your name)*Date* Date Format: MM slash DD slash YYYY Any special instructions or message that we should know? This iframe contains the logic required to handle Ajax powered Gravity Forms.