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Become a Member
Thank you for your interest in the StrucSure Remodelers Program
TM
. Please fill out the form below to apply for your membership in this program at a cost of
$295
Once we have received and reviewed your application and payment, we will contact you with next steps. There is also a
printable version
available.
If you are interested in learning how the StrucSure Remodelers Program process works,
click here
.
Remodeler Membership Application
1.
Name of Applicant Company:
DBA:
Address:
City:
State:
Zip:
Mailing Address:
City:
State:
Zip:
Phone:
Fax:
Email Address:
Cell:
Contact Person:
Federal Employers ID #
Parent Company:
2.
Type of business organization:- Sole Proprietor:
Partnership:
Corporation :
Other:
3.
State in which articles of organization or incorporation are filed:
4.
How long has Applicant Company been performing home improvements under its current name?
5.
List all Principals owning 10% or more of the Applicant Company
Name:
Title:
SSN:
Name:
Title:
SSN:
Name:
Title:
SSN:
(please email
remodelerapps@strucsure.com
if there are more)
6.
Has Applicant Company or any of its Principals ever filed bankruptcy or been adjudicated bankrupt within the past 5 years? Yes:
No:
If yes, please provide details:
7.
Has Applicant ever experienced any Workmanship/Systems, Structural and/or construction defect litigation claims in the past 5 years? Yes:
No:
If yes, please provide details:
8.
Is Applicant Company required to obtain a general contractor’s license from the jurisdiction in which it operates?
Yes:
No:
If “Yes” please list license number(s) and Jurisdiction(s)
9.
List all building department jurisdictions in which you build or intend to build.
Phone #:
Phone #:
Phone #:
(please email
remodelerapps@strucsure.com
if there are more)
10.
List Applicant Company’s Insurance Carriers:
General Liability Carrier Name:
Policy #:
GL Carrier Address:
GL Broker/Agent Name:
GL Phone:
Fax:
Expiration Date:
11.
Number of improvement projects you will enroll in the Program in the next 12 months:
Estimated value of home improvement project:
12.
In an effort to understand the impact of our marketing efforts (and dollars), will you please quickly tell us how you learned about StrucSure Home Warranty?
Partnerships / Alliances:
Remodeleze.com
Associations:
Home Builder Association:
SELECT
Anchorage HBA
BA of Victoria
BA of Western Nevada
BIA Hawaii
BIA of S. California
Big Country Builders Assoc.
BRC or Metro Denver
CAHB
Certified Master Builders Corporation
Construction Resource Group
Corpus Christi HBA
Deep East Texas BA
El Paso Assoc. of Builders
Georgia HBA
Greater Atlanta HBA
Greater Ft. Worth BA
Greater Houston BA
Great San Antonio BA
HBA of Denver
HBA of Greater Dallas
HBA of San Angelo
HBA of Savannah
Hill Country HBA
MBA of King and Snohomish Counties
NAHB
Temple Area BA
Texas Assoc. of Builders
Texas Panhandle BA
Tyler Area BA
Utah HBA
Other
NARI:
SELECT
National
Atlanta
Austin
Denver
Houston
San Antonio
Other
General Marketing/Communications:
Advertisements (print / online)
Trade Show
Special Event
Direct Mail Campaign
HTML Campaign
Press / Media
Phone Call
Referral Who Referred You?
Strucsure.com
Other
By submitting this form you hereby authorize StrucSure Home Warranty, LLC to conduct an investigation of the Applicant’s activities, make inquiries; obtain credit reports and insurance claims information as may be necessary to determine the financial and technical ability of the Applicant to meet its warranty obligations to Homeowners, SHW, and the Insurer. All information will be held strictly confidential. I hereby certify that all of the above information is true and correct to the best of my knowledge. I have read and agree to the terms of the
Golden Builders Association Membership Agreement
THIS APPLICATION IS BEING EXECUTED BY AN ELECTRONIC SIGNATURE. APPLICANT AGREES TO BE BOUND BY ITS ELECTRONIC SIGNATURE AND FURTHER AGREES THAT ANY SUCH ELECTRONIC SIGNATURE SHALL BE EQUALLY EFFECTIVE AS THOUGH IT WERE ORIGINAL.
Name of Person agreeing to these terms and conditions:
Please enter the anti spam code below:
