Application to become a Licensed Installer

Application to Become a Licensed Installer

Company Name:

Business Address:

City:

State:

Zip:

Telephone:

Email:

Years in Business:

Business Structure

Corporation

Partnership

Proprietorship

Business Principal(s)
(with Titles):

Experience in the Roofing Field:

	Yrs. Conventional Bur
	Yrs. Single Ply Membrane Rfg.
	Yrs. Substrate Repair & Replacement
	Yrs. Sheet Metal Work
	Current No. of Roofers
	Roofing Foremen
	Salesmen Employed

List Three (3) General Contractors for Whom You Have Done Work:

1) Name:
Address:
2) Name:
Address:
3) Name:
Address:

List Two (2) Architects for Whom You Have Done Work:

1) Name:
Address:
2) Name:
Address:

Credit Information:

Bank Reference:
Address:
Bank Contact:
Phone:
Account Number:

Trade Credit Reference:

1) Name:
Address:
Contact:
Phone:
2) Name:
Address:
Contact:
Phone:
3) Name:
Address:
Contact:
Phone:

Current Financial Statement:

Forthcoming by Email
Not Available

Important: By submitting this application, International Diamond Systems, Inc. is hereby authorized to examine and make inquiries concerning my credit and I hereby expressly authorize and give permission to any and all companies with whom I presently do business, to release any information International Diamond Systems, Inc. requires pertaining to my credit rating.