STRUCSURE HOME WARRANTY: OWNER / BUILDER MEMBERSHIP APPLICATION

Thank you for your interest in our structural home warranty program. Please complete the application below to enroll. Our enrollment fee is $295 and can be paid using a credit card once the application has been submitted. Once we have processed your application, we will send you a builder number and password along with instructions for enrolling your home(s) through our online portal.

If you have further questions about this program, please call 1.877.806.8777 or email info@strucsure.com

Applicant 1:

SSN:

Applicant 2:

SSN:

Address:

City:

State:

Zip:

Mailing Address:

City:

State: Zip:

Phone:

Fax:

Email:

Cell:

Is Applicant required to utilize a general contractor or licensed homebuilder from the locale in which it operates?

Yes

If "Yes", list name/license number(s).
Name/License Number:
TRCC Number (Texas Applicants Only)

Construction loan lender:

Name:

Contact:

Phone:

Address:

City:

State: Zip:

Owner/Builder Consultant's Information

Name:

Contact:

Phone:

Address:

City:

State:

Zip:

Email:

Does Applicant have General Liability Insurance? YesNo

Does Applicant have Builders Risk Insurance? YesNo

If "No", would you like more information on these insurance products?

Yes

Agreement:

The Agreement below describes the Terms and Conditions under which StrucSure Home Warranty will provide its services to you. As a StrucSure Home Warranty member, your activation of an account and receipt of StrucSure Home Warranty's services shall constitute your acceptance of this agreement and its Terms and Conditions will be legally binding upon you. Thank you for choosing StrucSure Home Warranty to be your home warranty service provider.

I hereby certify that all of the above information is true and correct to the best of my knowledge. I have read and agree to the terms of the Golden Builders Association Membership Agreement

THIS IS NOT AN APPLICATION FOR INSURANCE. THIS IS AN APPLICATION FOR MEMBERSHIP INTO THE STRUCSURE HOME WARRANTY PROGRAM. ACCEPTANCE INTO THE PROGRAM IS DISCRETIONARY AND DOES NOT CREATE INSURANCE OR WARRANTY COVERAGE.

THIS APPLICATION IS BEING EXECUTED BY AN ELECTRONIC SIGNATURE. THE UNDERSIGNED AGREES TO BE BOUND BY THE ELECTRONIC SIGNATURE AND FURTHER AGREES THAT ANY SUCH ELECTRONIC SIGNATURE SHALL BE EQUALLY EFFECTIVE AS THOUGH IT WERE AN ORIGINAL.

Name of Person agreeing to these terms/conditions:

The Membership Fee is $295.00