Installer Application - Persona Signs

Company Information
Please enter Company Name and Business Name per Lines 1 and 2 on your IRS Form W-9
Company Name (Enter from Line 1 of your IRS Form W-9)*
Business Name (Enter from Line 2 of your IRS Form W-9)
Shipping Address*
Street Address Address Line 2 - Optional City State / Province ZIP / Postal Code
Billing Address (If Different Than Shipping Address)
Street Address Address Line 2 - Optional City State / Province ZIP / Postal Code
Primary Contact Name*
First Name Last Name
Email Address*
Office Phone Number*
Mobile Phone Number
Is there a Secondary Contact for your business?*
Secondary Contact Name*
First Name Last Name
Email Address*
Office Phone Number*
Mobile Phone Number
Is there a Permitting Contact for your business?*
Permitting Contact Name*
First Name Last Name
Email Address*
Office Phone Number*
Mobile Phone Number
Is there a Service Contact for your business?*
Service Contact Name*
First Name Last Name
Email Address*
Office Phone Number*
Mobile Phone Number

Licenses and Certifications
Does your business have a Certified Welder?*
Please attach a copy of the Welding Certification(s) for each employee.
Drop files here or

Max. file size: 50 MB.
Does your business have an Electrical License?*
Is your business a Union Shop?*
Union(s) Represented
Does your business have a UL 48 Certification?*
Do you hold other Licenses and/or Certifications which you'd like Persona to be aware of?*
License Type*
License Number*
Name on License*
First Name Last Name
Expiration Date*
Do you have a second License or Certification to enter?*
License Type*
License Number*
Name on License*
First Name Last Name
Expiration Date*
Do you have a third License or Certification to enter?*
License Type*
License Number*
Name on License*
First Name Last Name
Expiration Date*
Do you have a fourth License or Certification to enter?*
License Type*
License Number*
Name on License*
First Name Last Name
Expiration Date*
Please list any additional Licenses or Certifications held.*

Please attach a copy of individual license(s) held for each employee (i.e. Crane Operator, Electrical Journeyman)
Drop files here or

Max. file size: 50 MB.

Photos and Documentation
Photos and Documentation*
Persona will review photos and documentation of your previous work prior to approval as our vendor. Please provide weld photos from a multi-stage structure. You must provide progressive photos, showing plug welds, cap ring, and flange welding.
Drop files here or

Max. file size: 50 MB.

Business Enterprise
Is your business (mark all that apply) :
- Minority-owned
- Woman owned
- Disadvantaged-owned
- Other - Please write in field below
Other Business Enterprise type

Coverage Area
Please provide a map of your service area, if available.
Max. file size: 50 MB.
If a coverage map is not available, please describe your coverage area (i.e. 50 mile radius of City, State)

Trade References
Customer References
These can be Owners, Architects, Subcontractors, or Sureties. ** Applications that do not include trade references will not be processed. **
Customer Reference 1*
Company Name Contact Name Address, City, State, ZIP Phone Number
Customer Reference 2*
Company Name Contact Name Address, City, State, ZIP Phone Number
Sub-contractor References
Sub-contractor Reference 1
Company Name Contact Name Address, City, State, ZIP Phone Number
Sub-contractor Reference 2
Company Name Contact Name Address, City, State, ZIP Sub-contractor 2 Phone Number
Sign Supplier References
Sign Supplier Reference 1
Company Name Contact Name Address, City, State, ZIP Phone Number
Sign Supplier Reference 2
Company Name Contact Name Address, City, State, ZIP Phone Number

Acknowledgements
Persona shall have the right to amend, revise, and update Terms & Conditions and Requirements at any time by providing written notice to Installer. Any amendments, revisions, or updates to Persona's Terms & Conditions and Requirements shall be effective if Persona provides written notice and shall apply to all Orders issued subsequent to the date of such notice. Installer understands this acknowledgement does not constitute an Order or commitment on behalf of Persona for any Products or Services.
I have received or have access to Persona's Installation Terms & Conditions*

** Imbed link to PO **
I have received or have access to Persona's In-Field Welding Requirements*

** Imbed link to In-Field Welding Requirements **
I have received or have access to Persona's Installer Insurance Requirements*

** Imbed link to Installer Insurance Requirements **
Acknowledged and agreed to by:
Name*
First Name Last Name
Title*
Date*
MM slash DD slash YYYY
Document Uploads
Please provide a copy of your IRS Form W-9*
Drop files here or

Max. file size: 50 MB.
Please provide a copy of your Certificate of Insurance (COI)*
Drop files here or

Max. file size: 50 MB.

Company Information

Company Name	Contact Name	Address, City, State, ZIP	Phone Number