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Contractor USA
Name
*
Company Name:
Phone Number:
*
Email
Willing to receive text messages, calls and emails?
*
YES
NO
Alternate Contact Name:
Alternate Contact Phone Number:
Alternate Contact Email:
What state do you live in
*
What city do you live in
*
State(s) where your company can do roofs
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virgina
Wisconsin
Wyoming
City(s) where your company can do roofs:
*
Zip Codes:
*
Website:
Do you have roofing licenses or certifications?
*
YES
NO
If you answered "YES" to the previous question, which ones?
Do you have commercial general liability insurance?
*
YES
NO
Do you have workers' compensation insurance? (Workman's Compensation)
*
YES
NO
Willing to do:
*
Residential
Commercial
Industrial
State
Federal
OTHER
Type of Systems:
*
Shingles
Woodshake
Modified
Torchdown
Built-up
TPO
PVC
EPDM
Tile
Steel
Metal
Coating
Hot Mops
Synthetic
Solar
Other Services that your company provides:
Requirements for roof groups:
Reference code (only applicable to a few)
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