Critical Home Repair Company Profile Form

The following information is required for any and all service providers, vendors and suppliers doing business of any kind with Knoxville Habitat for Humanity.

Company Name(Required)

Business Type(Required)

What are you bidding?(Required)

Is your company:

Certified Minority Owned

Certified Woman Owned

Other

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Company Phone(Required)

Company Fax(Required)

Contact Name(Required)

Contact Phone(Required)

Contact Email(Required)

Alternate Contact Name

Alternate Contact Phone

Alternate Contact Email

Company Tax ID

If Individual: Social Security Number

Date

File

Drop files here or

Max. file size: 50 MB.

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Name

This field is for validation purposes and should be left unchanged.