utm_source=website&utm_medium=direct&utm_campaign=sitefinity

Contractor Registration

INSTRUCTIONS FOR THIS REGISTRATION FORM
(to be completed by contractor)

1. For a smooth submission, we encourage you to save the following documents to your computer for ease of uploading:
          - Valid State License (If Required)
          - Current Liability Insurance
          - Current Workers Comp (If Required)
          - Completed W-9 Form
          - Lead Paint Certification (If LBP Certified)

2. Complete the Registration Form below and upload the required documents.

3. Click the Submit Button at the bottom of this page.

PROJECT INFORMATION

Estimated Renovation Project Budget*

CONTRACTOR / BUILDER DETAILS

Click here for IRS W9 Form

Upload your completed IRS W-9 Form:

Enter N/A if no license is required by state.

Upload a Copy of Your Contractor's License Here:
Are you Lead-Based Paint Certified?*
Upload a Copy of your Lead-Based Paint Certification Here
Do you have General Liability Insurance*
Upload your Certificate of General Liability Insurance:
Do you have Employees (excluding yourself)?
Upload your Workers Compensation Policy:
Has your Contractor's License ever been revoked?*
Are you or your business currently involved in any disputes, lawsuits, judgements, liens or surety bond claims?*
Have you, your business, officer or partner ever filed for or declared bankruptcy in a construction related business?*

PERMISSION AND RELEASE

Contractor Permission and Release

Please read and indicate your acceptance in the check box below. In consideration of the time and expense incurred by Primary Residential Mortgage, Inc("PRMI") in reviewing and evaluating this Contractor Registration and Questionnaire ("Questionnaire"); and to facilitate the review, analysis and investigation of the information contained herein by PRMI for and on behalf of the lender ("Lender") on the project(s) identified herein, I, on behalf of the above described Contractor ("Contractor") and myself, hereby grant permission for PRMI to review, confirm, and make such inquires as deemed necessary including without limitation the pulling of one or more, background checks, and public records databases on the business, responsible managing employees, responsible managing officers, and/or qualifying partners identified herein for the purposes of confirming the information contained in this Questionnaire and providing such information to the Lender. The Contractor hereby authorizes and directs all third parties listed herein to provide such information, records, verifications, confirmation and documents as may be requested by PRMI. On behalf of myself and the Contractor, and its parent, sister and affiliate companies, and its and their officers, agents, employees and independent contractors do hereby release, discharge, exonerate and covenant not to sue any person, company, association or any governmental organization providing information in the review and confirmation hereunder from any and all liability of every nature and kind arising from or in any way connected with the furnishing of information, the inspection of documents, records and other information, and the preparation, review and confirmation of any information provided to PRMI and submitted to the Lender hereunder

Certification - By submitting this contractor registration and by checking the certification box below, I certify the information contained herein is true and correct to the best of my knowledge and belief.