New Builder Registration

Interested in becoming a member of StrucSure Home Warranty and getting the best insurance-backed warranty coverage available in the industry on each home you build? If so, the first step is filling out our Builder Membership Application below. Once this application is received and approved and applicable membership fees are paid, we will send you a username and password for access to our online builder portal (typically within two to three business days). This portal contains all of the forms and information you need to enroll each of the homes you build for warranty coverage. It’s that simple! If you have questions, please contact us. Please click here if you would like a printable version of the application below.

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without a structural warranty, your company's assets and profits are greatly exposed, putting your bottom line in jeopardy.

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		New Builder Registration - $495

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 building homes 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 builderapps@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 builderapps@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 homes you will enroll in the Program in the next 12 months:
		Average Sales Price:

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: Builder Helper Remodeleze.com ServiceMagic Builder Radio Associations: Home Builder Association: NARI: General Marketing/Communications: Advertisements (print / online) Trade Show Special Event Direct Mail Campaign HTML Campaign Press / Media Phone Call Referral Who Referred You? Web site 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: