Supplier Onboarding Call Form

Company Name*

Primary Contact Name*

Phone

Business Address*

Required Documents (Please attach - Insurance is mandatory if making deliveries to job sites)

-IRS W-9 Form (signed and dated) ________________ -Certificate of Insurance (COI)_________________ Must include:___________________________________ • General Liability (Required if delivering)______________________________ • Workers’ Compensation (Required if delivering)____________________ • Auto Insurance (Required if applicable to your scope of work)_______________________________________ • Name LSWORKS LLC, 14310 Jefferson Ave, Orland Park, IL 60462 as:___________________________________________ o Certificate Holder_____________________________ o Additional Insured_____________________________ o Contractor License(s) (if applicable)_____________ If your company offers in-house credit accounts please include the application form or a link to the online form

Payment Information

(Select One)

Check

ACH Transfer (Direct Deposit) — Business Checking Accounts Only

If ACH Transfer is selected, please provide the following: (If Check - Type N/A)

Bank Name • Routing Number• Account Number • Account Type (Business Checking Only)

Type of Product(s)

License #

Federal Tax ID / EIN:

Business Structure

Corp/LLC/Sole Proprietorship/Other(Please List)

Number of Employees

Labor Structure

Union

Non-Union

Accounts Receivable Name

Accounts Receivable Phone

Accounts Receivable Email

Accounts Receivable Notes

Authorization

I certify that the information provided is true and complete to the best of my knowledge. I authorize LSWORKS LLC to use this information for business and payment purposes, including processing payments via ACH transfer to my business checking account if that payment method is selected. LSWorks LLC reserves the right to request updated Certificates of Insurance, W-9 Forms, licensing information, and other supporting documentation at any time as a condition of maintaining approved supplier status. Supplier acknowledges and agrees to comply with all LSWorks project site rules, safety requirements, and insurance requirements.

Yes