Contractor Application
Section 1. Contractor Information:
| First Name | *Required |
| Last Name |
*Required |
| Company Name | |
| Address | *Required |
| City | *Required |
| Zip | *Required |
| Phone | |
| Cell Phone | |
| Pager | |
| Fax | |
| *Required |
Section 2. Service Categories:
| Decks & Fences: | |
| Drywall/Sheetrock: | |
| Electrical: | |
| Flooring: | |
| Gutters:: | |
| Handyman: | |
| HVAC: | |
| Kitchen & Bath: | |
| Landscaping: | |
| Masonry & Tile: | |
| Painting: | |
| Plumbing: | |
| Remodeling: | |
| Roofing: | |
| Siding, Windows, and Doors | |
| Other: | |
Section 3. License Information:
| Name (as it appears on license) | |
| License Type | |
| License Number |
Section 4. Liability Insurance Information:
| Insurance Company | |
| Agent Name | |
| Agent Phone | |
| Coverage Amount | |
| Workman's Compensation? | Yes No |
| Bonded? | Yes No |
| If yes, what is your Identification Number for your Bond: | |
| Amount? | |
| Member of the Better Business Bureau? | Yes No |
| If yes, what is your Member Number: | |
| Other Member Associations: |
Section 5. Reference Information:
1. Reference |
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2. Reference |
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| 3. Reference Phone |
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| 4. Reference Phone |
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How did you hear about My Professional Contractor? |
| Thank you for completing our Contractor Membership Application. By clicking on the submit button, you hereby agree that all information provided in this form is accurate. A recruiting representative will be contacting you in the next day or two to set up a one on one meeting. |