| *Indicates Required Fields |
| Name* |
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| Street Address, City, State, Zip |
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| E-Mail Address |
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| Phone Number* |
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Fax Number |
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| Company Name* |
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| Company Street Address, City, State, Zip* |
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| Business License Number (If Applicable) |
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| Company Billing Address, City, State, Zip |
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| Types of Metal Roofing Installations Offered (Residential, Commercial, Post-Frame, Agricultural)* |
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| Types of Metal Roofing Installed (Through-Fastened, Screw-Flange Standing Seam, Etc.)* |
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| Number of Metal Roofing Installations Completed in Last 12 Months* |
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| Approximate Amount of Metal Roofing Purchases in Last 12 Months* |
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| Current Metal Roofing Supplier(s) Name and Contact Number* |
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| Current Metal Roofing Brand(s) Installed* |
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| Years of Experience Installing Metal Roofing* |
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| Please List Three References For Completed Jobs (Name and Phone Number)* |
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| Metal Roof Installation Training Completed* |
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| Number of Installation Crews (Sub-Contracted or Employees)* |
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| General Liability Insurance Provider* |
Policy Number* |
Amount of Coverage* |
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| Has Your Company Ever Filed for Bankruptcy Protection* |
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| If Yes, Explain:* |
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| Are there, or has there ever been, any lawsuits or judgements against your company?* |
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| If Yes, Explain:* |
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| Has your company or its owners ever operated under a different name?* |
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| If Yes, Explain: |
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| By Clicking Submit You Verify That This Information is Correct: |
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