Name *

First Name

Last Name

Phone *

(###)

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By clicking "yes" I certify that I have read the Project Restore Us Delivery Partner Agreement: *

I agree to indemnify and hold harmless Project Restore Us, and its respective affiliates, officers, agents, employees, and permitted successors and assigns against any and all claims, loses, damages, liabilities, penalties, punitive damages, expenses, reasonable legal fees and costs of any kind or amount whatsoever, which result from or arise out of any act or omission of the indemnifying party, its respective affiliates, officers, agents, employees, and permitted successors and assigns that occurs in connection with this Agreement. This indemnification will survive the termination of this Agreement.

Yes

The undersigned has, or will obtain, driver’s and car insurance relating to the services provided. *

Yes