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PUSH Ministry HOME Rehabilitation Program
Contractor Application for Firms and Individuals
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please select all that apply:
Minority-Owned Business
Woman-Owned Business
Small Business
Veteran-Owned Business
Do you have Property Damage/Liability Insurance?
Yes
No
Length of years in business:
Are you licensed by the State of Georgia Construction Industry Licensing Board?
Yes
No
Please list all other licenses and certifications:
Areas of Expertise/Experience:
Grading
Concrete
Framing
Roofing
Plumbing
Electricity
Energy-Certified HVAC
Flooring
Siding
Insulation
Drywall/Sheetrock
Interior Trim
Other
Lead Based Paint Certification
Yes
No
Credit Standing
Good
Fair
Needs Improvement
Jobs Completed:
Jobs in Progress:
Submit
Should be Empty:
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