Please print this page and mail or bring in to: Matt Kilburn, RS Express, 164 Kneeland St. Boston MA 02111
RS Express, Incorporated Independent Contractor Billing Info - Driver
Today's Date:_______/______/_______
Contractor/Company Name:_________________________________________________
Address:_______________________________________________________________
City/State/Zip Code:______________________________________________________
Telephone Number:_______________________ Pager Number:____________________
Federal ID Number/Social Security Number:_____________________________________
Proposed Start Date:______/______/______
Contractor Billing Number (RSX Internal Use Only):__________________
Hours/Days Service is Available:_______________________________________________________________
Type of Entity: (Circle one) Corporation Partnership Self-Employed
Type of Vehicle that will be used (Please include Year, Make and Model):
If Self-Employed, are principal and all assistants U.S. Citizens? YES______ NO______
Special Comments: Briefly describe any experience you have had in the courier industry or any particular points you may wish to cover during our decision process:
References: Please list 2 business references that we may contact to inquire about the quality of your services. These references must be current.
1. Company Name/Contact Person:___________________________________________
Telephone #: (____)______-______
2. Company Name/Contact Person:___________________________________________
Telephone #: (____)______-______
Note to All Applicants: You must have a clean driving record. All references and driving records will be checked. You must provide a copy of your current license, registration for the vehicle listed above and a current certificate of automobile insurance in the event your services are hired.
RSX Manager reviewing this information:________________ Date:______/______/______
Questions? Call 617.350.0247 between 7am and 8pm Monday- Friday.
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