Basic Listing Form

Thank you for your interest in a Basic 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 $49.95. A red asterisk (*) indicates required fields. If you'd rather have a printable form, click here.

*Company Name:
*Contact Person:
*Address Line 1:
Address Line 2:
*City:
*State:
*Zip/Postal 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? All contractors listed on RoofHelp.com must have proper insurance coverage.
You will be asked for a sample copy of your insurance certificate to accompany your payment.
Liability Insurance
Worker's Comp.

Type of work you do:
Click all that apply.
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

Please list any additional comments you'd like to make below:

Yes, I have read the terms and conditions and I am interested in more job opportunities by being listed in RoofHelp's database of roofing contractors. I understand that by clicking the "Submit Application" button, I am asserting that the above information is true and that I will be billed $49.95 for a 12 month listing. I also understand that if RoofHelp discovers any of the above licensing or insurance information to be false, I will be immediately removed from the database and no money can be refunded.