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FEATURED PRODUCT

Basement Watchdog Big Dog Battery Backup System Model BWD12-120C

Provide maximum protection for your basement with this powerful battery backup sump pump system. Pum...

Basement Waterproofing
Basement Finishing
Basement Remodeling
Concrete Repair
Finished Basements
Foundation Repair
Mold Removal
Sump Pumps

CURRENT RESOURCES
Accredited Contractors:	40
Provisional Contractors:	43
Total Contractors:	83
Total Suppliers:	8
Total Providers:	6

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May 17, 2008

The form below will automatically input your company into our database of Contractor Resources and Suppliers. You will be listed as a provisional Supplier until you have met the criteria to become accredited. Entering of erroneous information will result in your IP being banned from the entire site. Furthermore, abuse of this live real-time form will result in our need to remove real-time processing. Once you click submit, you will be able to find yourself listed as a BasementDepot Provisional Supplier. Read Instructions before completing the form below.

Your IP Address is: 38.103.63.16

Add Your Company to our Contractor Resource Database

CONTACT INFORMATION

Company Name:

DBA (if applicable):

Your First Name:

Your Last Name:

Address:

City:

State or Province:

Zip:

Country: (Non-US, Read This)

Phone: (Enter as 123-456-7890)

Toll Free:

Fax:

Email Address:

Confirm Email Address:

Website

http://www.

State License No.

License Exp Date

ABOUT YOUR COMPANY

Number of Employees:
Date Business Started:
Type of Company
Company Description (less than 300 characters including spaces):
Keywords for indexing (Separate words with spaces. No more than 100 characters including spaces):
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Do you sell wholesale?
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Company Logo [ HELP] Your logo must be no larger than 150x40 pixels and must be in gif format. Enter only the file name, i.e., if your logo is logo.gif, enter only "logo".	Upload Logo

SELECT YOUR SPECIALTIES (all that apply)

Waterproofing Supplier:
Foundation Supplier:
New Construction Supplier:
Refinishing Supplier:
Marketing:
Financial Services:
Tools:
Radon Supplier:
Water & Flood CleanUp Supplier:
Pest Control:
Financial Services:
Other: We are working on categories, so please input any category you would like to see

CREDIT CARD INFORMATION

As per The Basement Depot Contractors Agreement, your participation in the various programs and services of The Basement Depot is associated with certain fees ( Click for details). To insure uninterrupted service, please provide your credit card information below.

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Name on Credit Card:

Type of Credit Card:

Credit Card Number:

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Card Verification Number:

Expiration Date:

Billing address (where you receive your credit card bills), if different from above

Street:

City:

State:

Zip or Postal Code:

AGREEMENTS

I have read and agree to abide by the following:
NAWSRC Code of Ethics (enter YES)
NAWSRC Standards of Practice (enter YES)
BasementDepot Contractor Agreement (enter YES)
BasementDepot User Agreement (enter YES)

SIGNATURE

This document will not be "signed" in the sense of a traditional paper document. To verify the contents of this form, the signatory must enter any combination of alpha/numeric characters that has been specifically adopted to serve the function of their legal signature. Pursuant to the Federal Electronic Signatures in Global and National Commerce Act and applicable state laws, I consent to The Basement Depot's use and reliance on my electronic signature to verify the information that I have provided herein.
Today's Date:	05/17/2008
Your Signature:

My IP Address Is: 38.103.63.16

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