Authorized Contractor Application

Type of GCSM Warranty You Are Applying:*
- 5 Year
- 10 Year
- 15 Year
- 20 Year
Type of GCSM Warranty You Are Applying:*
- Level 1
- Level 2
- Level 3 (No Dollar Limit)
Type of System(s) Applying For (each system type will require training or past project examples)*
- GulfSeam™
- VersaLoc™
- MegaLoc™
- Other
Company Information
Company Name:*
Address*
Street Address Address Line 2 City State ZIP Code
Contact Name:*
First Last
Email*
Phone*

Applicant is a (check one):*
- Corporation
- Partnership
- Individual
- Joint Venture
- Other
Date Incorporated and Location:*
Date Organized and Location:*
General Partner:*
Limited Partner:*
Where registered:*
Principal:*
Other (list here):*
Your GCSM Representative:*
Employer Identification Number:*
Corporation (Partnership/Sole Proprietor) Number:*
State(s)/Province(s) licensed to do business in:*
List branch offices you wish to be considered for approval. Attach separate application for each office.*
How long has this entity been in business as a contractor?*

Experience of Key Business Participants:
President Name*
First Last
President Years of Roofing Experience*
President Prior Construction Experience (Business, Type, Years)
Vice President Name*
First Last
Vice President Years of Roofing Experience*
Vice President Prior Construction Experience (Business, Type, Years)
Other Officer(s) Name(s)
First Last
Other Officer(s) Years of Experience*
Other Officer(s) Prior Construction Experience (Business, Type, Years)*
Estimator(s) Name
First Last
Estimator(s) Years of Experience*
Project Manager(s)
First Last
Project Manager(s) Years of Experience*
Supervisor(s)
First Last
Supervisor(s) Years of Experience*
What percent of your work is performed by your own employees?*
Please enter a number from 0 to 100.

If at least 75% of your work is not performed by your own employees, describe how the work is normally contracted.*
Have you ever failed to complete work contracted to this business or been named as a party in any construction related litigation?*
- Yes
- No
If yes, please describe in detail.*
Have any of the above-named principals been employed by any contracting firm that has failed to complete work it contracted to perform or has been named as a party in any construction-related litigation?*
- Yes
- No
If yes, please provide detail.*
Has your company or any of its principals been named a party in any bankruptcy petition?*
- Yes
- No
Is your company involved in any litigation at this time?*
- Yes
- No
If yes, please identify any such case; describe what the case is about; the parties; type and amount of claim being made.*
What percentage of your work has been done in the following categories over the last three years? The sum percentages should total 100%.*
Percent of work
Residential Commercial Shingles Cold Process
What percentage of your work has been done in the following categories over the last three years? The sum percentages should total 100%.*
Percent guaranteed
Residential Commercial Shingles Cold Process
Over the last three years, your residential work is:*
If no work of this type is performed, select “static."
- Growing
- Declining
- Static
Over the last three years, your commercial work is:*
If no work of this type is performed, select “static."
- Growing
- Declining
- Static
Over the last three years, your shingles work is:*
If no work of this type is performed, select “static."
- Growing
- Declining
- Static
Over the last three years, your cold process work is:*
If no work of this type is performed, select “static."
- Growing
- Declining
- Static

Built Up Roofing
What percentage of your work has been done in the following categories over the last three years?*
Percent of Work
Singe Ply Roofing Modified Bitumen Roofing Foam Roofing Foam Wall Metal Roofing Exposed Fastener Snap Lock Mechanical Seam
What percentage of your work has been done in the following categories over the last three years?*
Percent Guaranteed
Singe Ply Roofing Modified Bitumen Roofing Foam Roofing Foam Wall Metal Roofing Exposed Fastener Snap Lock Mechanical Seam
Over the last three years, your single ply roofing work is:*
- Growing
- Declining
- Static
Over the last three years, your modified bitumen roofing work is:*
- Growing
- Declining
- Static
Over the last three years, your foam roofing work is:*
- Growing
- Declining
- Static
Over the last three years, your foam wall work is:*
- Growing
- Declining
- Static
Over the last three years, your metal roofing work is:*
- Growing
- Declining
- Static
Over the last three years, your exposed fastener work is:*
- Growing
- Declining
- Static
Over the last three years, your snap lock work is:*
- Growing
- Declining
- Static
Over the last three years, your mechanical seam work is:*
- Growing
- Declining
- Static

List five separate projects in each of the categories you are applying for that were completed in the last two years.
Project One*
Project Owner Material Supplier Project Size Spec Description Month/Year Completed
Project Two*
Project Owner Material Supplier Project Size Spec Description Month/Year Completed
Project Three*
Project Owner Material Supplier Project Size Spec Description Month/Year Completed
Project Four*
Project Owner Material Supplier Project Size Spec Description Month/Year Completed
Project Five*
Project Owner Material Supplier Project Size Spec Description Month/Year Completed
Please upload a word document with additional projects completed in the last two years for each other category you are applying.
Drop files here or

Max. file size: 100 MB.
Include project, owner, material supplier, project size, spec description, and month/year completed for each project.
What quality control procedures do you normally apply to projects to assure proper installation?*

Financial Section
NOTE: If the applicant already has a completed credit agreement with GCSM's Accounts Receivable Department prior to applying to become a GCSM authorized contractor, it is not necessary to complete the financial sections of this application.
Do you already have a completed credit agreement with GCSM's Account Receivable Department?
- Yes
- No

Vendor One
Vendor Name Address Phone
Vendor Two
Vendor Name Address Phone
Vendor Three
Vendor Name Address Phone
Vendor Four
Vendor Name Address Phone
Bank Reference One:*
Bank Address Phone
Bank Reference Two:*
Bank Address Phone

Please list associations in which your firm holds memberships.*
Include association name, address, and phone number.
List manufacturers/marketers of roofing or waterproofing systems you have current applicator agreements with.*
Include company name(s) and type of agreement(s).

Signature Page
1. The undersigned officer of the business named below hereby certifies that the information provided herein is true and accurate, offered for the purpose of having Gulf Coast Supply and Manufacturing (GCSM) rely thereon, in order to approve this contractor's application as a GCSM Authorized Contractor (CONTRACTOR), which entitles such CONTRACTOR to apply for GCSM Warranties from GCSM and commits such entity to apply such systems in accordance with GCSM applicable specifications and good construction practices.
2. Contractor certifies by signing below that they hold all necessary licenses to perform roofing work in the jurisdictions listed on the application and agrees to notify GCSM if a necessary license expires, is revoked or otherwise terminated.
3. If the applicant already has a completed credit agreement with GCSM's Accounts Receivable Department prior to applying to become a GCSM authorized contractor, it is not necessary to complete the financial sections of this application.
4.
GCSM is hereby authorized to investigate credit history and Dunn & Bradstreet reports to confirm the data provided in this application.
Name*
First Last
Date*
MM slash DD slash YYYY
Signature*
The following must be attached to application for it to be processed:
Proof of Liability Insurance*
Max. file size: 100 MB.
Proof of Worker's Compensation (Canada - WSIB Clearance Letter/Certificate)*
Max. file size: 100 MB.
Copies of all business and contractor license(s) required to perform work in the states or province(s) listed on application.*
Max. file size: 100 MB.
Copies of your business's safety program*
Max. file size: 100 MB.
PLEASE ALLOW TWO WEEKS FOR REVIEW AND PROCESSING. YOU WILL BE NOTIFIED AS TO WHETHER OR NOT YOU AUTHORIZED WITHIN THAT TIME FRAME.

The Trusted Name in Metal Roofing Since 1996

1-888-393-0335

Authorized Contractor Application

Step 1 of 10

Company Information

Experience of Key Business Participants:

Built Up Roofing

Financial Section

Signature Page

The following must be attached to application for it to be processed:

Singe Ply Roofing	Modified Bitumen Roofing	Foam Roofing	Foam Wall	Metal Roofing	Exposed Fastener	Snap Lock	Mechanical Seam

Project	Owner	Material Supplier	Project Size	Spec Description	Month/Year Completed

Residential	Commercial	Shingles	Cold Process

Residential	Commercial	Shingles	Cold Process

Vendor Name	Address	Phone

Vendor Name	Address	Phone