Glep - Vendor Onboarding Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Company Name *Contact Person *FirstLast pending Incorporation/Organization have Company Structure *--- Select Choice ---CorporationLLC (Limited Liability Company)PartnershipSole ProprietorshipJoint VentureTraditional PartnershipLimited PartnershipLimited Liability PartnershipState of Incorporation/Organization *--- Select Choice ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCompany WebsiteContact Email *Contact PhoneAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFederal Employer Identification Number (XX-XXXXXXX) *Company Logo Drag & Drop Files, Choose Files to Upload Compliance Information and Internal Policies (e.g., Privacy Policy, Code of Conduct, Data Protection Policy, etc.) Drag & Drop Files, Choose Files to Upload You can upload up to 25 files. Provide all of your final, signed policies. Please provide copies of all notices from regulatory agencies, insurance companies, or customers accusing you of violating any law, rule, or regulation, and steps taken to remediate such claims, if applicable. Please provide copies of the following Policies and/or disclosures: (1) Privacy Policy, (2) Complaint Policy and Log, (3) Compliance Training Policy, (4) Compliance Management System (CMS), (5) Vendor Risk Management Policy and Program, (6) Corrective Action Policy, and (7) Audit Policy - requiring internal monitoring and testing of compliance operations. Please also provide all scripts and other customer facing documents that will be used as part of this relationship. Written responses for: Compliance Information and Internal Policies (e.g., Privacy Policy, Code of Conduct, Data Protection Policy, etc.) *Please list applicable laws your company must abide by - specific laws to your company. Does your company comply with all applicable Federal and State Laws? Is your company required to be licensed or registered to provide services? Please provide list of licenses/registrations (if applicable).Legal InformationIf applicable, please provide a list of all material lawsuits and regulatory actions for the past five years.General Liability Insurance * Drag & Drop Files, Choose Files to Upload Please provide proof of general liability insurance in an amount commensurate with the risk involved in the conduct and operation of your business.Principal Information *Please provide the following information for any individual or entity that meets any of the criteria below: Owns 10% or more of the company, directly or indirectly Exercises significant control or influence over management, operations, strategy, or key decision-making Has special rights (e.g., veto rights, board seats, control agreements) Provides material financial support or guarantees Acts as a parent company, sponsor, or control person For each qualifying Principal, provide: Full Name / Legal Entity Name Role/Relationship to the Company Ownership Percentage (if any) Description of Control or Influence Address and Contact Information Date of Birth (individual) or Formation Date (entity) Government ID or Entity Registration Number Citizenship / Country of Formation Disclosure of litigation, regulatory actions, criminal history, or conflicts of interestHave you, or a company you were an officer/principal of, previously been subject to any lawsuits or orders? *YesNoDoes your company currently have any pending lawsuits or orders? *YesNoDoes/will your company receive and retain sensitive consumer information? *YesNoSignature * Clear Signature I certify all of the above information in this form are true and accurate.Submit
