Tripartite Escrow Agreement Request

TRIPARTITE ESCROW AGREEMENT REQUEST

A contractor generally only has ten (10) calendar days once awarded a contract to provide the Contracting Officer with a payment protection, i.e., escrow agreement, payment bond, etc.

If you have already executed a Service Agreement, please complete the below Escrow Request Form for a Tripartite Escrow Agreement.

The request will be prepared and you will receive your Tripartite Escrow Agreement via e-mail.

You need that least one Subcontractor or Supplier for your Tripartite Escrow Agreement.

You can add all you want later at no cost. It will save time to only put one Subcontractor or Supplier.

COMPANY INFORMATION:

Company Name:

Agency Name:

Person in Charge of Contract:

Title:

Agency Address:

Agency City:

Agency State:

Agency Zip:

Agency Phone Number:

Agency Email:

Project Title:

Contract Number:

Contract Amount:

Contract Date:

FIRST SUBCONTRACTOR OR SUPPLIER: The Email address that is enter will be the one the complete escrow agreement will be Email to.

SUBCONTRACTOR SUPPLIER

Company Name:

Person Name:

Title (Owner, CEO, etc):

Address:

City:

State:

Zip:

Telephone Number:

Email:

SECOND SUBCONTRACTOR OR SUPPLIER: The Email address that is enter will be the one the complete escrow agreement will be Email to.

SUBCONTRACTOR SUPPLIER

Company Name:

Person Name:

Title (Owner, CEO, etc):

Address:

City:

State:

Zip:

Telephone Number:

Email:

THIRD SUBCONTRACTOR OR SUPPLIER: The Email address that is enter will be the one the complete escrow agreement will be Email to.

SUBCONTRACTOR SUPPLIER

Company Name:

Person Name:

Title (Owner, CEO, etc):

Address:

City:

State:

Zip:

Telephone Number:

Email:

Notes:

TRIPARTITE ESCROW AGREEMENT REQUEST

COMPANY INFORMATION:

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