Fleetwash, Inc.

Independent Contractor
Employment

Contact Information
* Company Name
* Your Name
* Address Line 1
* Address Line 2
* City
* State
* Zip
* Phone Number
* E-mail

Experience
* Years of Experience
* Years Self Employed
* Serviceable Areas (City/State)

* Type of Pressure Washing Experience	Truck Washing Yes No
	House Washing Yes No
	Building Washing Yes No
	Car Dealership Vehicles Yes No
	Other (List below)

Insurance Information
* Liabilty Insurance:	Yes No
* Name of Insurance Company:
* Workmans Comp Insurance:	Yes No
* Name of Insurance Company:
* Automotive Insurance Company:
Additional Comments

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Contact Information