Installer Application Form Company Name*Contact Name*FirstLastWebsiteAddress*Street AddressCityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZIP CodePhone*Email*Company InformationAnnual gross revenue:*Number of years in business:*Number of Install crews:*Number of Licensed electricians:*List three professional trade references:*Dollar amount of liability insurance coverage:*List any products that your company currently sells:*Describe the percentage makeup of your work types.*Industrial _% Service _% Commercial _% Residential _%Choose the geographic area that your company currently services:*Northern CaliforniaCentral CaliforniaSouthern CaliforniaNorthwestSouthwestMidwestSoutheastNortheastAreas of Expertise (check all that apply)*What areas of expertise do your installers have?HVAC (exhaust fans, blowers, rooftop units)Fan InstallationLighting/Electrical Installation (all inquiring contractors MUST have licensed electricians on staff)General Contractors (concrete, sheetrock)List any licenses, special skills or equipment you have.*Are you licensed in HVAC? Do you have a 60-ft. scissor lift? Tell us! In what states do you currently hold licenses, and what types?*Tell us why Big Ass Fans should consider you as an exclusive installation crew:*EmailThis field is for validation purposes and should be left unchanged.