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Contractor/Agent Application

Vehicle Information

Please provide current certificate of insurance for auto policy.

Work History

List two companies you have contracted with to provide delivery services.

First Contract

Dates Worked:

Second Contract

Dates Worked:

To the best of my knowledge the above information is accurate and truthful. I understand that I am completing this information in order to contract my services as a self-employed independent contractor and not as the employee of any company.

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