Apply For Membership - Southern Living Custom Builder

Apply For Membership

Company

Web Site

License Number

Year Business was Founded

Houses Built Last Year

Annual Dollar Volume

Price Range

$250-500K

$500-1 million

More than $1 million

Square footage of average home built last year

Please list any conferences or courses you attended related to new products or the construction industry in the last two years

Please list any trade and/or professional associations to which you belong

What products are you currently using for

Windows

HVAC

Plumbing

Flooring

Paint

Appliances

General Liability Insurance Carrier

Name

Address

Phone Number

Policy Number

Worker’s Comp Insurance Carrier

Name

Address

Phone Number

Policy Number

Business References

Company

Contact

Phone Number

Company

Contact

Phone Number

Homeowner references (from your two most recent projects)

Name

Phone

Name

Phone

Construction Lenders

Loan Officer

Telephone

Company

Credit Line

Address

IF YOU ANSWER YES TO ANY OF THE FOLLOWING QUESTIONS, YOU MUST PROVIDE A FULL EXPLANATION.

Within the past 3 years, have you pled guilty or nolo contendre, or been convicted of a felony of any crime relating to the residential construction business?

Within the past 3 years, were you or any company of which you were either a partner, officer, or member declared or placed in bankruptcy?

Within the past 3 years, did you or any company of which you were a partner, officer, or member have any professional or business license revoked or suspended?

Are there any liens for labor or materials filed on any of your work or the work of any firm of which you are a partner, officer, or member?

Within the past 3 years, were you or any company of which you were either a partner, officer, or member sued because of a matter involving a residential construction business? If yes, you must submit a copy of complaint.

Explaination

We will maintain all information contained on the application in strictest confidence. You represent that this information is true and accurate, and understand that if the information is not accurate, we may terminate your participation in the Southern Living Custom Builder Program.

Application DateDecember 12th, 2024

Type in your name to represent a signature on this application