New Vendor Registration

Company Name*

Primary Address 1*

Primary Address 2

City*

State*

Zip Code*

Website*

Federal Tax ID*

Billing Address 1*

Billing Address 2

City*

State*

Zip Code*

Company LinkedIn page

Company Contact Information

Primary Contact Name*

Title*

Email*

Office Phone*

Mobile Phone*

Customer Support Contact*

Title*

Email*

Office Phone*

Mobile Phone*

Backup Contact Name*

Title*

Email*

Office Phone*

Mobile Phone*

Legal Contact Name*

Firm Name (if external)

Email*

Office Phone*

Mobile Phone*

Billing Contact Name*

Title*

Email*

Office Phone*

Mobile Phone*

Job Order Routing Information

Orders are routed to Revilix Preferred Services Providers via email. Please indicate the email addresses where ALL job orders should be sent.

Job Order Email / Send to*

Secondary Email / CC

This address will receive a CC email of the job order as a backup

Number of Employees*

Years in Business*

Business Insurance Carrier*

Insurance Policy Number*

Please attach or upload policy information at the bottom of this page

Tax Exempt Business*

Yes

If "Yes", Please attach or upload documentation at the bottom of this page

Number of Locations*

ISO Certifications

Company Security Information

Building has secured access for employees (ex: electronic badges)*

Building has security cameras in use*

Building has active alarm system*

Company has security officer(s) on site*

Building has locking cabinets for secure document/item storage*

Company has disaster recovery plan in place for catastrophic event*

Company has data security policies, procedures and education*

Company has IT and data security expertise in-house or external resource*

Company has a cyberattack / data breach response plan prepared*

Company stores business and/or customer data in the cloud*

Company has experienced a cybersecurity event in the last 24 months*

Company HIPPA Compliance

Company is HIPAA compliant*

Company has a HIPAA Compliance training program for employees*

Company's HIPAA practices are independently audited*

Most recent Company HIPAA compliance audit date*

File attachment or Document link

Please upload Proof of Insurance file and IRS W-9 Form to confirm Tax ID

Upload Files

Post Link

Maximum file attachment size = 25MB

If a required file is larger than 25MB, please upload to cloud storage and paste a link in the specified field or email directly to [email protected]

Add link to online file storage (ex:Dropbox)

Please check at least one litigation support services category your company provides*

Reprographics and Trial Support services (ex: blowbacks / copying / binders / audio & video)

Forensics and E-discovery Services

Court Reporting Services

Records Retrieval and Medical Summary Services

Process Services

Reprographics and Traditional Services Information

Services offered - Select all that apply*

Audio/Video Duplication

Bates labeling

Binding

Blowbacks

Conversion

Copying (Color/B&W)

Oversize

Scan/Label/OCR/Load files

Translation service

Trial Boards

Equipment information

Total number of color copiers available

Total number of B+W copiers available

Total number of oversize copiers available

Total number of scanners available

Total number of binding machines available

Forensics and E-discovery Services

Services offered - Select all that apply*

Data collection/forensics

Electronic data discovery

Hosting

Forensics and E-discovery Services details

What city(ies) are your forensic labs located in?

Do you have specific insurance for your electronic forensics business?*

Do you have chain-of-custody procedures in place?*

Do you have experts who are experienced in providing testimony?*

Do you have expertise in providing forensic analysis in criminal cases?*

Do you have expertise in providing forensic analysis in civil cases?*

Court Reporting Services

Service offered - Select all that apply*

Court Reporting details

Court reporting certification or license number*

Certification / license state*

Does the firm employ non-certified court reporters?*

Please indicate the services provided by your firm(check all that apply)

Streaming / Video conferencing*

Remote online depositions*

Telephone conference call set up*

Expedited turnaround*

Standard turnaround time*

Electronic scheduling*

Electronic copies of transcripts*

Please indicate the formats available for transcripts(check all that apply)

ASCII

RealLegal PTX

Adobe PDF

Records Retrieval and Medical Summary Services

Services offered - Select all that apply*

Affidavit with Authorization

Subpoena

Records Retrieval and Medical Summary Details

Do your employees seek and maintain professional certifications?*

If yes, please list active certifications:

Do you contract with or employ 3rd party vendors, external experts or strategic partners to perform services?*

If yes, please list vendors and tasks performed:

Do you utilize specific software applications or tools to perform tasks?*

If yes, please list software or applications:

Do you utilize proprietary software applications to perform duties?*

If yes, please list software or applications:

Process Services Details

Service offered - Select all that apply*

Does you company offer skip-trace or locate services*

Do any employees have an active Private Investigator license?*

If "Yes", please provide the following details

First and Last Name

State(s) Licensed In

Primary State License Number

First and Last Name

State(s) Licensed In

Primary State License Number

First and Last Name

State(s) Licensed In

Primary State License Number

Do you perform stake-outs or surveillance?*

Do you file service returns?*

Do you retrieve documents and/or files from courthouses?*

Do you use process servers who are employees of the company?*

Do you use process servers who are independent contractors?*

Have any process servers (employees) had any grievences filed against them?*

Does the company handle Prospective New Client sign-ups for Personal Injury attorneys?*

Do you have notaries on staff?*

Do you prepare and/or issue subpoenas?*

Can you cover witness fees?*

Do you have procedures in place for receiving documents from courthouses (ex:e-issuances)?*

Revilix will invoice the client at the completion of each job order. Invoice pricing is determined in advance and stipulated in the Revilix User Agreement unless otherwise specified. Job orders are non-refundable and non-cancelable. Client agrees to payment terms dictated by and listed on each invoice. Client agrees that they are responsible for the payment of any/allRevilix invoices. Late invoice payments are subject to interest rates at 1 ½% per month of the full invoice amount.

Privileged and/or confidential information may be contained in Revilix and Preferres Service Provider messages. If you are not the addressee indicated in this message (or responsible for delivery of the message to such person), you may not copy or deliverthis message to anyone. In such case, you should destroy this message and notify the sender by reply e-mail. Please contactReviliximmediately at (832) 347-5510 if you or your employer do not consent to Internet e-mail for messages of this kind. Opinions, conclusions and other information in this message that do not relate to the official business of Revilix or its subsidiaries shall be understood as neither given nor endorsed by it.

New Vendor Registration

Company Information

Company Contact Information

Job Order Routing Information

Company Information

Company Security Information

Company HIPPA Compliance

File attachment or Document link

Maximum file attachment size = 25MB

Add link to online file storage (ex:Dropbox)

Service(s) Provided

Reprographics and Traditional Services Information

Services offered - Select all that apply*

Equipment information

Forensics and E-discovery Services

Services offered - Select all that apply*

Forensics and E-discovery Services details

Court Reporting Services

Service offered - Select all that apply*

Court Reporting details

Records Retrieval and Medical Summary Services

Services offered - Select all that apply*

Records Retrieval and Medical Summary Details

Process Services Details

Service offered - Select all that apply*

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