Contractor Application

First Name *

Last Name *

Email *

Company Name:

What is your company address?* 

Phone #* 

Fax #* 

South Carolina LLR License Number* 

Name of Liability Insurance Company * 

Policy # of Liability Insurance?* 

Name of Workers Compensation Insurance Company* 

Policy # of Workers Compensation Insurance* 

Fee for Estimate? ( if yes - go no further)* 
Yes  No

Can you EMAIL estimates within 12 hours?* 
Yes  No

Trash Outs?* 
Yes  No

Re-Keys?* 
Yes  No

Lawn Maintenence?* 
Yes  No

Cleaning Services?* 
Yes  No

Winterizations?* 
Yes  No

Painting Services?* 
Yes - Interior and Exterior  Yes - Interior Only  Yes - Exterior Only  No

Major Repair Items? Over $5000* 
Yes  No

Minor Repairs? Under $4000* 
Yes  No