Champion Contractor Recruitment

First Name:*

Last Name:*

E-mail:

*Please provide email to receive confirmation.

Company:

Job Title:

Business Phone:*

Mobile Phone:

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Champion Location?:*

*Please choose the Champion location that is closest to you.

Lead Source:*

How did you hear about this opportunity?

Liability Insurance:*

Do you currently have liability insurance? Minimum Limits General Liability: • $1,000,000 each occurrence • $100,000 Damage to rented premises • $5,000 Medical Expenses • $1,000,000 Personal & Adv Injury • $2,000,000 General Aggregate • $2,000,000 Products-Comp/OP agg.

Automobile Insurance:*

Do you currently have automobile insurance? • Automobile Liability $300,00 Combined Single Limit

WC Insurance:*

Do you currently have Workman's Compensation insurance? Minimum Limits Worker's Compensation: •$100,000 E.L each accident •$100,000 E.L Disease each employee •$500,000 E.L Disease policy limit * Include Other States endorsement or minimum required by state law, whichever is greater Description: Coverage must include all states in which the contractor works or resides

Background Check:*

Will you submit to a background check if selected by Champion?

RRP Certified:*

Are you currently RRP Certified? Follow Link below to clearly define the RRP requirements:

RRP Certification Link: RRP Requirements

# of Employees:

Please select the number of employee's in your company.

Please indicate Yes or No to the products you are qualified to work on:

Windows:*

Doors:*

Siding:*

Roofing:*

Sunrooms:*

Electrical:*

Concrete:*