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June 18, 2013

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Carrier Questionnaire

Independent Contract Newspaper Carrier Questionnaire

<strong>All form fields are required and must be completed for your entry to be successful.<p> The following information will be used to make contracting decisions and thus will be reviewed for accuracy. Any discrepancies or omissions may have an impact on the contracting process. <p>

Business Name (required):

Owner's Name (required):

Social Security Number or Federal Tax ID Number (required):

Street Address (required):

City (required):

State (required):

Zip Code (required):

Telephone # (required):

Desired Delivery Area (required):

List Delivery Vehicles (Year/Make) (required):

Automobile Insurance Carrier (required):

Automobile Policy Limits (required):

Driver's License Number (required):

State of License (required):

Have you ever been bonded? (required):

If yes, with what company?:

Have you ever had a bond declined or canceled? (required):

If yes, please explain:

Have you ever been an independent contract newspaper carrier? (required):

If yes, for what publication(s)?:

Have you ever been convicted of a felony within the last seven years? (required):

If yes, please explain:

Business Reference 1 (required): Name, Address & Telephone Number

Business Reference 2 (required): Name, Address & Telephone Number

Business Reference 3: Name, Address & Telephone Number

Are you human? Sorry, we have to be sure. This helps us prevent abuse of our business directory by automated programs. Just look at the letters in the image depicted below, and type what you see into the provided field.

Download Questionnaire

Carrier Questionnaire

Questionnaire may be mailed to either The Paducah Sun, 408 Kentucky Avenue, Paducah, KY 42003; or should be hand-delivered to the reception desk, The Paducah Sun, 408 Kentucky Ave. Office hours are 8 a.m. to 4:30 p.m., Monday-Friday. E-mail to jhall@paducahsun.com

For additional information, contact Jason Hall, Circulation Operations Manager 270-575-8781.

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