CLIENT APPLICATION CLIENT APPLICATION 1. THE BUSINESSBusiness Name *Physical AddressCityState/ProvinceZIP / Postal CodeMailing AddressCityState/ProvinceZIP / Postal CodeCredit ScoreCredit ReportChoose FileNo file chosenDelete uploaded fileEmail AddressAre annual revenues of the business more than $1,000,000YesNoWebsiteNumber of owners/shareholders in this entity:State of IncorporationYear of IncorporationState(s) Registered In2. BUSINESS OWNER AND OFFICER INFORMATIONThe following must be detailed: (A.) each person with 20% or more ownership AND (B.) any officer. Ownership Percentage and/or Role:– Ownership Percentage and/or Role:NameCellular NumberOffice NumberEmail AddressHomes BuiltYears in Single Family ConstructionAdditional years in Commercial ConstructionResume AttachedYesNoMarried?YesNoName of SpouseCurrently employed by a third-party?YesNoFull timePart timeEmployer NameYear Employed– Ownership Percentage and/or Role:NameCellular NumberOffice NumberEmail AddressHomes BuiltYears in Single Family ConstructionAdditional years in Commercial ConstructionResume AttachedYesNoMarried?YesNoName of SpouseCurrently employed by a third-party?YesNoFull timePart timeEmployer NameYear Employed– Ownership Percentage and/or Role:NameCellular NumberOffice NumberEmail AddressHomes BuiltYears in Single Family ConstructionAdditional years in Commercial ConstructionResume AttachedYesNoMarried?YesNoName of SpouseCurrently employed by a third-party?YesNoFull timePart timeEmployer NameYear EmployedAny additional full-time employees or part-time employees? Please list.3. RECENT HISTORY10 most recent projects sold (2012 and later only)Date SoldSales PriceAddressNew Build? Y/N4. CONTRACTOR’S LICENSEState IssuedLicense #License ever been revoked?YesNoExplain5. REFERENCESBANKING REFERENCE (the primary bank for business accounts)Bank NameContact NameTRADE SUBCONTRACTOR REFERENCECompanyContact NameSUPPLY COMPANY REFERENCECompanyContact NameTRADE SUBCONTRACTOR REFERENCECompanyContact NameOPTIONAL – SECOND BANKING/FINANCIAL REFERENCECompanyContact NamePhone NumberEmailYears working with them?I have reviewed items 1 – 5 of the application including all additional paperwork (resumes, etc.). I hereby certify, represent, and warrantthat all statements are accurate to the best of my knowledge. Note: The individual with the largest percentage of ownership in theborrowing entity per item {2} should sign this document. The other signature, if any, should be the primary preparer of this document.SignatureSignatureNameNameDateDateSend Message
