Application Date

Company Name

Contractor Registration Number (if applicable)

Name

Title

Mailing Address

Email

Telephone (Office)

Fax Number

Cell Phone Number

Company Website

Business Description (select one)

Type of Business or Service

Number of Employees

How Many Years in Business?

How did you learn about the Builders Association?

Insurance Provider for Liability (Minimum coverage required is $1,000,000.00 per occurence)

Policy Number

Insurance Provider for Workers Comp

Policy Number

Please provide 3 Names and Titles of Partners or Corporate Officials

Please Provide 2 Banking References (Company, Contact Person and Phone Numnber)

Please Provide 3 Additional Financial References (Names and Phone Numbers)

If You Are a Builder, Please Indicate the Type of Construction You Do

If In the Building Industry for Less than 2 Years, State Prior Business Experince

List Three Major Sub-Contractors

Please Select YES to authorize the BACP to conduct such investigation of the Applicant's activities, make such inquiries and obtain such credit reports as may be necessary for its determination of the Applicant's financial ability to meet its obligations.

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