Thank you for your interest in a Verified listing in RoofHelp.com's contractor database. Simply print this form and either mail it to us at the address located at the bottom of this page.

*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.

How much aggregate insurance do you carry? $_____________________

Types and percentage of work you do:
______% Residential
______% Commercial / Industrial

Types of roofing and roof-related construction:
(Please check all that apply)
___ Roofing Contractor
___ Roofing & Sheet Metal Work
___ Roof Repairs
___ Roofing and Gutter Work

Does your firm have its own in-house sheet metal shop?
___ Yes ___ No

What types of work does your company specialize in?

___ Asphalt Shingles and Roll Roofing	___ Modifieds - APP
___ Built-Up (Asphalt)	___ Modifieds - Coal Tar
___ Built-Up (Coal Tar)	___ Modifieds - SBS
___ Coatings - Acrylic	___ Polyurethane Foam
___ Coatings - Chopped Fiberglass and Emulsion	___ Single-Ply - EPDM
___ Coatings - Cut-Back Asphalt and Ceramic Granules	___ Single-Ply - Hypalon
___ Coatings - Emulsified Aluminum	___ Single-Ply - PIB
___ Coatings - Plural Component Urethanes	___ Single-Ply - PVC
___ Coatings - Silicone	___ Single-Ply - TPO
___ Cold Process	___ Slate
___ Metal - Standing Seam	___ Tile - Clay
___ Metal - Copper	___ Tile - Concrete
	___ Wood Roofing

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

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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.

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