Company name Company contact Address County Phone office Phone fax Phone cell Phone home Phone pager Website Email Organization type - Select -SubcontractorSupplierBothCorporationPartnershipProprietorship Numbers of house worked last year Numbers of houses worked on highest ever Numbers of house worked on current capacity Numbers of workers employed min this year Numbers of workers employed currently Numbers of workers employed highest ever Are your tradesman employees or subcontractors? Employees Subcontractor Do you subcontract any portions of your work? Yes No When on the job, is your foreman present? Yes No Other business involvements? Federal Tax ID # State Tax ID # Employee Sec # Liability Insurance Company Liability Insurance Company Agent Liability insurance company phone Liability insurance company policy # Liability insurance company policy exp date Bank reference name Bank reference phone number Are you bonded? Yes No If bonded, company name If bonded company, how much? Material or equipment suppliers that you use Please list name, address & phone Will materials be shipped to the jobsite direct from the suppliers (Mat'l Waiver Req'd) or will you bring them? Yes No Please list 3 jobs you are presently working on or have completed (Job1) Please list builder, address, contact, and phone Please list 3 jobs you are presently working on or have completed (Job2) Please list builder, address, contact, and phone Please list 3 jobs you are presently working on or have completed (Job3) Please list builder, address, contact, and phone Describe your corporate safety policy and philosophy Have you ever been cited by OSHA for any violations, accidents, injuries (describe) Describe your policy on customer service Service work contact Service work phone Emergency warranty work contact Emergency warranty work phone Any additional comments Leave this field blank
