Apply as Provider | Leads To Business

Apply as a Provider

Apply to join our vetted contractor roster

Legal Business Name

First name

Last name

Business Email

Direct Cell Phone

Physical Business Address (no PO Boxes)

Years in Business

License Type (leave blank if not yet licensed)

B

C-42

C-13

Other

Hawaii DCCA License Number (leave blank if not yet licensed)

License Expiration Date (leave blank if not yet licensed)

Don’t have a Certificate of Insurance (COI) yet? That’s normal — not a dealbreaker.

Most solo operators don’t carry a COI day one. It’s a one-page form your insurance agent can email you in 10 minutes. Don’t have one? Next Insurance can usually get you a policy and COI same-day — click here. (Full disclosure: we get a small referral credit if you check them out, doesn’t cost you anything extra.) You can submit your application now and upload your COI once you have it — don’t let three letters stop you from applying.

Insurance acknowledgment

I will provide a current Certificate of Insurance naming Leads to Business Hawaii as additional insured before activation.

File upload

Online Review Profile Link

Have you had any license suspensions, unresolved complaints, or legal actions related to your work in the past 5 years?

If yes, explain

Certification & authorization

I certify all information in this application is accurate and complete. I authorize Leads to Business Hawaii to contact references, verify my license with Hawaii DCCA, and conduct any complaint or background research deemed appropriate. I understand that false information will result in immediate removal from the program.

Printed Full Name

Date

Month

Day

Year