Verified Listing Form

Thank you for your interest in a Verified Listing in RoofHelp.com's contractor database. Simply fill out the form below and click the "Submit" button. Your information will automatically be sent to RoofHelp.com and you will be sent an invoice for $199.95. A red asterisk (*) indicates required fields. If you'd rather have a printable form to fill out and mail, click here.

*Company Name:
*Company Contact Person:
*Address Line 1:
Address Line 2:
*City:
*State:
*Zip Code:	-
*Phone:	() ext.
*Fax:	()
E-Mail:
Web Site Address:	http://
Dun & Bradstreet:	--

Some states require that roofing contractors be licensed while other states do not. If required, are you licensed in your state of business? Yes
Click here to see if your state requires a license.

*Do you carry insurance?
Liability Insurance
Worker's Comp.

*How much aggregate insurance do you carry?

*Type and percentage of work you do:
% - Residential
% - Commercial/Industrial

*What types of roof-related construction does your company do? Please check all that apply.
Roofing Contractor
Roofing and Sheet Metal Work
Roof Repairs
Roofing and Gutter Work

Does your firm have its own in-house sheet metal shop?
Yes

*What types of roofing is your company proficient at?
Asphalt Shingles & Roll Roofing
Built-Up - Asphalt
Built-Up - Coal Tar
Coatings - Acrylic
Coatings - Chopped Fiberglass & Emulsion
Coatings - Cut-Back Asphalt and Ceramic Granules
Coatings - Emulsified Aluminum
Coatings - Plural Component Urethane
Coatings - Silicone
Cold Process
Metal - Copper
Metal - Standing Seam
Modifieds - APP
Modifieds - Coal Tar
Modifieds - SBS
Polyurethane Foam
Single-Ply - EPDM
Single-Ply - PIB
Single-Ply - TPO
Single-Ply - PVC
Single-Ply - Hypalon
Slate
Tile - Clay
Tile - Cement
Wood Roofing
Other

Are you a certified applicator with any manufacturers?
Examples: Firestone Master Contractor, GAF Certified Master Elite Contractor, etc.

List any comments you'd like to make:

Example Comments:
We are asbestos abatement certified.
We are a bonded firm.
Our employees are OSHA-safety trained.
Our firm does HVAC work, etc.

Yes, I have read the terms and conditions and I am interested in more job opportunities by becoming a RoofHelp Verified contractor. I understand that by clicking the "Submit Application" button below, I will be billed for $199.95 and that I am allowing RoofHelp to do a background check on my company. If I qualify, I will be listed for 12 months in RoofHelp's database of nationwide contractors as a RoofHelp Verified roofing contractor. I also understand that if any of the above information is found to be false, I may be immediately removed from the database and no money can be refunded.