contractorapp | Infinitemassage

mobile service provider- independent contractor application

Please submit the following application via fax: (866) 715-7465

A copy of your Liability Insurance Policy
A copy of your Massage License
A copy of your Business Card

Submitted by admin on Thu, 01/14/2010 - 12:03

First Name:: *

Last Name:: *

Street Address::

City::

State::

Zip Code::

Nearest Metro Area::

Primary Phone::

Secondary Phone::

E-Mail Address: : *

Company Name: (optional):

What type of service provider are you?:

Insurance & Licensing (if applicable)

Liability Insurance Provider:

Professional License:

Liability Insurance Policy #:

License Number:

Liability Insurance Exp Date:

License Exp. Date:

Professional References

Reference #1:

Reference #2:

Phone Number::

Relationship::

miscellaneous

How many total hours of professional training have you had?:

Have you had specific training in Chair Massage?:

How many years have you been practicing?:

Can you provide all the necessary equipment & supplies?:

Do you have your own practice and/or do you provide services for other companies or individuals?:

Additional Comments::

contact us

Please feel free to email or call. We look forward to hearing from you!

> 1.866.RELAX.88

407.956.5350

> info@infinitemassage.com

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