DC Builder Application

Please fill out the form below:

Company Name:

Your Name: *

Street Address: *

City/State/Zip: *

Office Phone #

Home Phone #

Cell Phone #

Fax #

Website

Date: *

Federal ID# or SS #: *

Email: *

Additional Information

Principal/Individual Name(s): *

Home Address: *

City/State/Zip: *

SS #: *

Principal/Individual Name(s):

Home Address:

City/State/Zip:

SS #:

Years of Residential Experience:

Years of Commercial Experience:

Total Years Building Experience:

Years experience in the following:

General Contracting:

Framing:

Interior Rough:

Interior Finish:

Roofing/Siding:

Distance willing to travel: *

State Contractor License #: *

Business References

Name: *

Address: *

Phone: *

Name:

Address:

Phone:

Financial/Bank References

Name: *

Address: *

Phone: *

Name:

Address:

Phone:

Managers Name:

I/we, the undersigned, do hereby make application for designation as an Independent Dealer/Builder of DC Structures Inc. I/we authorize DCS, or its representatives, to make inquiries to the above names references, and others if necessary, and to conduct such further background checks (including, without limitation, criminal background checks, credit checks, and department of motor vehicle record searches) to determine my/our eligibility for consideration as an Independent Builder/Dealer of DCS. I /we acknowledge that if designated as an Independent Dealer/Builder, DCS may revoke such designation at any time.

Signed: *

Date: *

Signed:

Date:

DC Structures