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Thank you for your interest in a Basic listing in RoofHelp.com's
contractor database. Simply print this form and either mail it or fax it to us. An
asterisk (*) indicates required fields. |
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| *Company Name: | _________________________________________ |
| *Contact Person: | _________________________________________ |
| *Mailing Address: | _________________________________________ |
| *City: | __________________________ |
| *State | __________________________ |
| *Zip | __________________________ |
| *Phone: | __________________________ |
| Fax: | __________________________ |
| E-Mail: | __________________________ |
| Website Address (if applicable): | _________________________________________ |
| 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___ NO___ |
|
| *Do
you carry insurance? All contractors listed on RoofHelp.com must have proper insurance
coverage. Please submit a copy of your insurance certificate with your payment. ___ Liability Insurance ___ Worker's Comp. What types of work does
your company do? ____Residential ____Commercial / Industrial |
|
| Yes, I am interested in
more job opportunities by being listed in RoofHelp's database of roofing contractors. I
understand that by by signing below, I am asserting that the above information is true. 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 will
be refunded. Please list comments on the back of this sheet or on a separate sheet. |
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| Payment: | ||
| Send form and payment for $49.95 to: | ||
| Roofhelp | ||
| 1608 South Timber Ct. | ||
| Fort Worth, TX 76126 | ||
| Tel: 817.249.5020 | ||
| Or fax completed form to: | ||
| 817.887.1442 | ||
| Secure line - delivered via Email |
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