1.
SHW Representative:
Tiffany Acree
D'Ann Brown
Scott Whisenant
Stacie Locke
Cheryl Jones
John Sizemore
Cindy Huber
Mike Dougherty
Whitney Balaun
Mike Scrimo
I don't know
2.
Name of Company:
DBA:
Billing Address:
City:
Mailing Address:
City:
Phone Number:
Fax Number:
Cellular Number:
Email Address:
Web Site:
Contact Person:
Federal Employers ID #:
Parent Company:
3.
Type of Business/Org.:
4.
State in which articles of organization or incorporation are filed:
5.
How many years has the Company been remodeling under its current name?
6.
List all principals owning 10% or more of the Company
Name:
Title:
SSN:
Name:
Name:
(Please email builderapps@strucsure.com
if there are more than three)
7.
Has Company or any of it's Principals ever filed bankruptcy or been adjuncted
bankruptcy within the past 5 years?
If Yes, please provide details:
8.
Has Company ever experienced any workmanship/system, structural and/or
construction defect litigation claims in the past 5 years?
If Yes, please provide details:
9.
Is Company required to obtain a general contractor's license from the
jurisdiction in which it operates?
If Yes, please list license number(s) and jurisdiction(s):
10.
List all building department jurisdictions in which you build or intend to build.
(Please email builderapps@strucsure.com
if there are more than three)
11.
List Companys current General Liability Insurance carrier:
GL Carrier Name:
GL Carrier Address:
GL City:
GL Broker/Agent Name:
GL Phone Number:
GL Policy Expiration:
12.
How many homes will you enroll with StrucSure over the next 12 months?
Average remodeling contract price:
$
13.
In an effort to understand the impact of our marketing efforts (and dollars), will
you please quickly tell us how you learned about StrucSure Home Warranty?
General Marketing / Communications:
Referral
Who Referred you?
Other
Other Reason:
