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REGISTRATION | Contractor

Company Information

UserName : *
Password : *
Retype your password : *
Company Name : *
Company Contact: First Name : *
Company Contact: Last Name : *
Company Address : *
City: *
State: *
Postal Code: *
Business Phone:	(xxx-xxx-xxxx)
Mobile Phone :	(xxx-xxx-xxxx)
Fax :	(xxx-xxx-xxxx)
Email Address :*
Company Website :	i.e.http://www.abc.com.
In Business Since Year ("yyyy") :
Residential Contractor : *	YesNo
Commercial Contractor : *	YesNo
24 Hour Emergency Service : *	YesNo
Number of employees :
Company Description :* Tell us all about you. Why should you be hired. This is an area where it may pay off to be very detailed and share as much about your company as possible.
License Info :
If no License Info Available, Check Here
Professional Affiliations : (eg. NARI, Better Business Bureau, Chamber of Commerce, etc.)

Insurance Information:

Do you have workers' compensation insurance?

Yes No

Do you have general liability insurance?

Yes No

Liability Insurance Carrier
Policy Number
Expiration Date	(xx-xx-xxxx)

Do you have automotive insurance?

Yes No

Automotive Insurance Carrier
Policy Number
Expiration Date	(xx-xx-xxxx)

Additional Information

Customer Reference #1

Name:

Address:

Phone No:

Customer Reference #2

Name:

Address:

Phone No:

Customer Reference #3

Name:

Address:

Phone No:

Do you accept credit cards?:	YesNo
Do you offer financing? :	YesNo
Are you certified to install environmentally-friendly products or solutions?	YesNo
Are you able to advise homeowners on envionmentally-friendly products or solutions?	YesNo
State/Local License Number:
Annual Sales (in dollars) :

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