Vendor Sign Up | Lux Management Group

Are you applying as an individual or a business? *

Individual Business / Organization

First Name *

Last Name *

Social Security Number (SSN) * Required for W-9. Transmitted securely and used for tax reporting only.

Legal Business Name * Must match your EIN registration exactly.

Business Name / DBA

Point of Contact Name * Primary person we will work with day-to-day.

Tax Classification *

Employer Identification Number (EIN) *

I do not have an EIN

Contact Information

Business Address

Services Offered

Service Areas

Arizona: Specific areas you cover

Phoenix Metro Northern Arizona Southern Arizona Statewide / All of AZ

Specific cities, zip codes, or notes (optional)

Alabama: Specific areas you cover

Birmingham Metro Huntsville / Madison Mobile / Gulf Coast Statewide / All of AL

Specific cities, zip codes, or notes (optional)

Florida: Specific areas you cover

Orlando / Central FL Tampa / St. Pete South Florida Statewide / All of FL

Specific cities, zip codes, or notes (optional)

Licensing & Bonding

License Number *

Licensed For *

Expiration Date

General Liability Insurance

Insurance Company *

Policy Number *

Expiration Date *

Coverage Amount

Insurance Agent

Agent Phone

Workers Compensation

Workers Comp Carrier *

Policy Number *

Expiration Date *

Coverage Amount

WC Agent

Agent Phone

If you do not carry workers compensation insurance, you must acknowledge the following exemption.

I acknowledge that I do not carry workers compensation insurance. I agree to hold Lux Management Group harmless for any work-related injuries sustained by myself or my employees while performing services on behalf of Lux Management Group properties.

Payment Information (ACH)

Your banking information is encrypted and used solely to process payments for completed work. It is never stored in plaintext.

Documents

Certificate of Insurance (COI) * PDF or image. Must show Lux Management Group as certificate holder.

Business / Contractor License PDF or image of your current license.

Additional Information

A member of our team will review your application and follow up if needed. W-9 documentation will be sent to your email for e-signature.

Vendor Type

Contact Information

Business Address

Services Offered

Service Areas

Licensing & Bonding

General Liability Insurance

Workers Compensation

Payment Information (ACH)

Documents

Additional Information

Application Received