Concierge Service Submission - The Insurance Fox

Homeowner Concierge Service

Vendor Name*

Mailing Address*

City*

State*

ZipCode*

Website*

Email Address*

Phone*

Fax

Contact Person*

Title*

Email*

Best Contact Number*

Area/region you do business:

City(s)*

County(s)*

State(s)*

Description of your business operation*

Years in business*

Brief description about your company and yourself*

Logo or photo you would like to accompany your vendor listing (attach)*

Upload

Vendor Guidelines

1. All vendor positions are for a year term and renew on an automatic basis.

2. If you do not wish to renew your vendor position, you must notify us in writing NO LATER than 60 days prior to your renewal date.

3. All payments are non-refundable.

4. We must maintain a copy of your current license where applicable.

5. We must have a signed Waiver of Liability and Hold Harmless agreement on file.

6. Vendor cost is $350 per year and will renew automatically unless we are notified in writing NO LATER than 60 days prior to your renewal date.

7. Changes can be made to your vendor description as needed.

I agree to the above guidelines

Signature*

Title*

Date*

CREDIT CARD AUTHORIZATION FORM

Cardholder Name*

TYPE OF CARD

Visa

Master

Card Number*

Please Select

Please select
January
February
March
April
May
June
July
August
September
October
November
December

Expiration Month*

Please Select

Please select
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
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2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050

Expiration Year*

CVC*

CARD BILLING ADDRESS*

I authorize The Insurance Fox LLC/Homeowner Concierge Service to charge $500 to the credit card above. I also authorize The Insurance Fox LLC/Homeowner Concierge Service to charge the same amount on the renewal date of my vendorship unless I notify them in writing no later than 60 days prior to my renewal date.

Signature*

Print Name*

Title*

Date*

HOLD HARMLESS AND WAIVER OF LIABILITY

This HOLD HARMLESS AGREEMENT AND WAIVER OF LIABILITY (The “Agreement”) is made as of

(date) by and between The Insurance Fox LLC (the “Indemnitee”) located at 2557 Nursery Rd., Suite B, Clearwater FL, 33764 and

(the Indemnifier”) located at

Indemnifier shall hold The Insurance Fox LLC harmless and waive all and any liability in conjunction with any bodily injury and/or property damage that may arise out of the Indemnifier’s operations as part of advertising with The Insurance Fox LLC on the website www.theinsurancefox1.com under Homeowner Concierge Service.

The Insurance Fox LLC

Date

Indemnitee Signature*

Date*

Indemnitee Name (Print)*

Title*

I agree with the company's Privacy Policy and Terms of Use

Vendor Guidelines

CREDIT CARD AUTHORIZATION FORM

HOLD HARMLESS AND WAIVER OF LIABILITY

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