Partners

Contractor Application Form

 

Thank you for your interest in the 4Liberty Partner Program. We are always interested in expanding our network to include partners who are at the top of their field. 

The following application includes all the basic information we require in order to begin the process. Please allow approximately 15 to 20 minutes to complete form. 

 

 Company / Branch Information:
Firm Name: 
 
Contact: 
Address: 
 
Phone: 
Suite/Floor: 
 
Fax: 
City: 
 
Cell: 
State: 
 
Email: 
Zip: 
 
Website: 
Main Phone: 
     
 
 Corporate / Billing Information:
Job Name : 
 
Contact: 
Address: 
 
Phone: 
Suite/Floor: 
 
Fax: 
City: 
 
Cell: 
State: 
 
Email: 
Zip: 
 
Website: 
Main Phone: 
     
A/P Contact: 
 
A/R Contact: 
 
 Contact Information:
Contact #1
Name:
Title:
Email:
Phone:
Fax:
Cell:
Contact #2
Name:
Title:
Email:
Phone:
Fax:
Cell:
Contact #3
Name:
Title:
Email:
Phone:
Fax:
Cell:
 
 General Information:
Do you have a contrators license?
Yes / No
If so what is your license number?
What type of license do you have? C-7, C-10?
Do you carry liability insurance?
Yes / No
Carrier / Policy Number
How much insurance coverage do you carry?
When does it expire?
Is your company union or non-union?
If union, which union CWA or IBEW?
What is your hourly rate for cabling?
What is you hourly rate for service/repair?
How many installers and service technicians do you have?
 
Installers
Service Techs
What is your standard warranty?
Do you have other branches?
Yes / No
If so where?
Do you provide 24-hour on call service coverage?
Yes / No
How does it work?
Do you have a website?
Can you transfer information electronically?
   
 
 Cabling Service:
What is your company certified in as far as cable, connecting and terminating hardware?
Product
Cert.
Qual.
Product
Cert.
Qual.
Product
Cert
Qual
Panduit
Homaco
Berk-Tek
AMP
Chatsworth
Mohawk
Siemon
Avaya
Comm-Scope
Ortronics
Corning
Beldon
Leviton
Bogen
Valcom
Hubble
Mod-Tap
Nordex
   
           
Other Qualifications:
 What type of cabling networks are you certified or qualified in to install?
Product
Cert.
Qual.
Product
Cert.
Qual.
Product
Cert
Qual
Ethernet
Video
Data
Thinnet
CATV
Security
Fiber
Twinax
Fire Alarm
Outside Plant
Coax
Access Control
Voice
Paging
 
Sound
Aerial
 
   
           
Can you provide category 5e and or 6 and 6E testing and certification?
Yes / No
Do you own your own tester?
Yes / No
What kind and what brand name tester?
We need floor plans, cablerecords, test results, and digital photos in electronic format. Can you provide?
Yes / No
Do you have capabilites for:
 
CAD
Yes / No
Visio
Yes / No
Adobe
Yes / No
Explain:
 
 Types of Typical Jobs your company feels comfortable working on:
Voice Only
Video
PC Tech Work
Data Only
Tone, indentify/reuse
Wireless LANS
Voice/Data
Point of Sale installation
Residential
(new construction)
Paging
Fiber
Smart Homes
Security
Backbone
   
CATV
Campus
   
 
Other:
 
 Phone Systems :
Do you install, service, maintain or work on any of the following phone systems?
     
Certified
 
Systems
Yes
No
Yes
No
 
Norstar
 
Panasonic
 
Lucent
 
Toshiba
 
AT&T
 
Inter-Tel
 
Vertical Networks
 
Other
 
Any other phone systems you are certified or qualified on? Explain:
 
 PC Service / IT Skills:
Do you have any of the following certifications?
A+ , MCSE , Other
What is your hourly rate for PC tech work
(not including software)?
 
Simple
$ /hr.
Complex
$ /hr.
Can you install, troubleshoot and or repair
any of the following?
 
Router
Hubs
Switches
Desktop PC
Other
Do you have experience with POS(point of sale)?
Yes / No
 
Explain:
 
 Response Time:
Can your company meet the following time frames?
Respond within 2-hours for any inquiry? Yes / No
Arrive onsite within 4 business hours for trouble call? Yes / No
Arrive onsite within 8-hours for a trouble call? Yes / No
Verify completion onsite the same day? Yes / No
Verify Invoice within 2-business days? Yes / No
Return hard copy along with quality assurance
form within 5-business days?
Yes / No
 
 Electrical Capabilities:
Are you a licensed C-10 Electrician? Yes / No
Can you provide conduit and electrical work? Yes / No
Explain:
Do you do any trenching or coring?  
 
 General Notes:


Thank you for completing this application to become a certified 4Liberty Partner. We appreciate your interest in 4Liberty. Someone will follow-up with you within 3 business days regarding the status of your application. Please feel free to call us at (619) 400-1000 if you have any questions.