Username
Email
First Name
Last Name
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Industry Involvement (check up to 3 that apply, 3 per member company will be listed on printed chapter materials.)
Advertising, Marketing & Printing Appliances Banking/Financing
Cabinetry or Closets-Design/Custom Concrete Construction Demolition Design and Drafting Services
Design Build/Remodeling Designs
Electrical-Contractor/Service & Repair Electronics/Home Theater Exterior Remodeling - Roofing, siding, soffits and gutters, vinyl decks, outdoor lighting
Exterior Remodeling - Supplier Flooring (tile, hardwood floors, carpet) General Contractor
Heating & Air Conditioning Insulation Contractor Insurance
Interior Design Consultants Interior Finishes (fireplace, countertops, shower doors, mirrors, door hardware, knobs & pulls)
Landscape/Hardscapes Legal Light Fixtures, Fans & Lighting Control Systems Lumberyards/Building Suppliers Marble, Granite & Slate
Movers New Construction Painting Contractors Plumbers Plumbing Suppliers Real Estate Remodeling - Commercial Remodeling Residential (kitchens, baths, basements, decks, carpentry, additions, whole house remodels, repairs) Utilities Water Drainage Systems Contractor/Basement Waterproofing Windows, Doors, Storm Doors - Suppliers Windows - Contractors Other
If other, list segment
Company Name
Year Established (optional)
Your Title (optional)
Street Address
City
State
Zip Code
Telephone
Fax (optional)
Cell Phone (optional)
Company Website
Sponsor/Referring NARI Member (if applicable/optional)
Have you previously held NARI membership? If so, when? (if applicable/optional)
Certifications - please list CR, CKBR, CRPM, UDCP (if applicable/optional)
Have you conducted your business in compliance with the NARI Code of Ethics in the past year? Please type Yes or No. Link to NARI Code of Ethics
Has/does the applicant or any company owned applicant’s owner(s), or any of applicant’s owner(s), directors, officers, managing employees or qualifying person:
A. Ever been convicted of a crime or been involved in any incident where physical harm or threatened toward another person or sexual assault occurred?
B. Have any mechanics liens or lien foreclosures (excluding pre-lien notices) filed against any of your projects that have remained unresolved for longer than one year?
C. Ever been a principal or officer of a building or remodeling business whose contractor’s license has been revoked, suspended or denied?
D. Have any unjustified judgments?
E. Filed for bankruptcy or protection from creditors within the last 5 years?
F. Had any formal administrative action taken by any local, state or federal authority against your business and or your state contractor license?
G. Have any unresolved issues with the Better Business Bureau?
Please type Yes or No, below.
If you answered Yes to any of the above questions, please provide a thorough explanation below. If you answered No, type N/A below.
Licensed Contractors - please list class A, B, C, D, E and all that apply (if applicable/optional)
State registration and local business license number (if applicable/optional)
Liability Insurance Company (if applicable/optional)
Policy Number (if applicable/optional)
What is your main purpose of joining Omaha NARI? (For example: networking, branding, education, or you can type in another reason.)
Other Information (optional)
