Fabricator & Trade Partner Registration Form
Personal Information
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Do you have an LLC or Company name?
Yes
No
Company Info
If sole proprietor please, put your name as company name.
Company Name
*
Company Email
*
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Phone Number
Please enter a valid phone number.
Can you accept full slab deliveries?
Please Select
YES, I have the equipment to unload stone slabs
NO, I do not have the equipment to unload stone slabs
Company Tax ID
AZ ROC Numbered
Qualifications
List any relevant certifications or licenses
*
Equipment
List any equipment currently in use for fabrication and installation
*
Insurance Information
Provide proof of General Liability Insurance with a minimum coverage of $1,000,000
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Provide proof of Workers' Compensation Insurance
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signature
By signing below, I certify that the information provided in this form is true and accurate. I understand that any false information may result in termination of my agreement with Groma Consulting Group, Inc. (Surprise Granite DBA).
Signature of Subcontractor
*
Signed Date
*
/
Month
/
Day
Year
Date
Submit
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