Prequalification Form

Why join the Rosie on the House Referral Network of preferred partners?

Tens of thousands of Arizona homeowners know Rosie through his Rosie on the House radio show and his weekly columns in the Arizona Republic and Tucson Citizen.
Rosie's loyal listeners trust him to recommend only Arizona's finest contractors-so they check his Referral Network before any other source.
The Rosie on the House Referral Network is available to anybody with a telephone or access to the Internet.
Rosie's online Referral Network lists contractors by trade so homeowners can quickly and easily find Rosie's picks for their specific jobs.
The "Rosie Certified" logo means "quality" and "trustworthiness" to Rosie's listeners. Preferred contractors can use the logo on their letterheads, Web sites and trucks.

Get started by filling out the questionnaire below. A Rosie on the House team member will contact you shortly.

Prequalification of Tradesmen - Questionnaire

Company Name: *

Region: *

Address: *

City: *

State: *

Zip Code: *

Office Phone: *

Fax:

Emergency:

URL (Web site):

E-mail: *

Owner Name: *	Mobile Number:	Years in Trade:
Manager Name: *	Mobile Number:	Years in Trade:
Superintendent Name:	Mobile Number:	Years in Trade:
Sales Name:	Mobile Number:	Years in Trade:

Type of Organization: *

List all Services your company provides: *

Example:

Restoration, preservation and maintenance of ceramic tile and grout

All natural stones i.e. travertine, granite etc.

Concrete pavers

What Category are you interested in?

What Subcategory are you interested in?

Years in business within
the Phoenix Metro Area: *

Year your company was established: *

Hours of business operation: *

Service area: *

Licensing (indicate license held, type and expiration date):

Residential License No.:	Type:	Expiration Date:
Commercial License No.:	Type:	Expiration Date:
Other License No.:	Type:	Expiration Date:

Are all licenses in good standing?
Yes No

If no, please explain:

Has there ever been a company name or license number change?
Yes No

If yes, please explain:

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