Intake Form | National Low Voltage Systems Integrator

Welcome to our Authorized Partner Resource page.

If you are an independent contractor with a valid business license and you have a basic business liability insurance policy please take a moment to complete our “Partner Intake Form” to become an Authorized Partner Resource with GA LVT INC.

Once you have completed our intake form Vendor Relations Team Member will contact you to take the next step.

You can also send eMail inquiries to: vendors@galvt.us

THANK YOU FOR YOUR INTEREST!

FULL Legal Name *

First

Middle

Last

Home Address *

Include street address, city, state and zip code

Cell Phone *

Where we can reach you in case of emergencies, etc.

Personal eMail Address

Business Name

Full legal name of your company

Business Mailing Address

Include street address, city, state and zip code

Business Physical Address

Include street address, city, state and zip code (if different from your mailing address)

Are you incorporated? *

Corporate Tax ID (EIN/TIN) *

If you are incorporated, please enter your EIN/TIN

Office Number *

Business eMail Address

Business Internet Site Address

Please enter the complete internet site address. ie. https://www.galvt.net

Years you have been in business?

Hourly Billing Rate *

Marital Status *

Spouces Name

First

Middle

Last

If applicable

Spouses Employer

Spouses Work Phone

Number where we can reach your spouse in case of an emergency

Spouses Cell Phone

EMERGENCY CONTACT INFO *

If other than your spouse. NAME - CELL NUMBER - RELATIONSHIP

Phone

A Conkel Family Trust Company d/b/a GA LVT INC.