Asphalt Repair, Maintenance & Sealcoating

Please submit your online company profile.
This information will be used as part of our screening process as well as the data for your listing on our website referral lists.
This may take up to 10 to 15 minutes to complete from start to finish. To make the process fast and simple, have these basic documents ready to upload, email or fax:
- Company Ownership Documentation (Proof of ownership)
- Copies of city, county or state licenses
- A copy of a recent proposal which includes your warranty information
- Workers Compensation/General Liability Insurance Agent Name and Contact Information
- Customer References

Account Login

Name Of Person Who Will Be Managing Your Account

1. First Name *

2. Last Name *

3. Email Address* (This will be your login username) *

Copy of submitted application will be sent to this email address

Company Information

Please enter your company information

4. Legal Company Name *

5. Date Started MM/YY *

6. Is your company publicly traded or owned by an investment firm?

Yes

No - Privately Owned

6a. Company Manager First and Last Name *

6b. Company Manager Email Address *

Copy of submitted application will be sent to this email address

6a. How many owner's of your company?

6b. Company Owner First and Last Name *

6c. Company Owner Email Address *

Copy of submitted application will be sent to this email address

6d. Company Owner #2 First and Last Name *

6e. Company Owner #2 Email Address *

6f. Company Owner #3 First and Last Name *

6g. Company Owner #3 Email Address *

Additional Company Owners

6h. Please list additional company owners First Name, Last Name and Email Address. 1 Line per owner.

7. Main Company Telephone *

8. Company Web Site Address

Please leave blank if no company website

9. Company Mailing Address *

Suite

City *

County *

State *

Zip Code *

Internal Contact

Please list an internal contact within your company that can always be reached if needed.
(For our office internal use only) Please no answering services

10. Internal Contact First and Last Name*

11. Internal Contact Phone*

Business Entity Information

12. Is Your Company Registered Within The State You Operate Your Company? *

Yes

12a. Do you have a copy of your state business registration on your computer available to upload? *

Yes

No - I will email/fax a copy to the approval department after submitting the application

Please upload a copy of your state business registration:

12b. How do you file your business income taxes? *

Sole Proprietor

LLC

Corporation

In order to verify ownership of the company creating this profile, we will need documentation proving ownership and length of time in business. Examples: A bank statement, a letter from your bank on bank letterhead, a copy of a tax return from year started, or a letter from your accountant.

12c. Do you have a copy of your business articles of incorporation on your computer available to upload? (LLC or Corporation)

Yes

No - I will email/fax a copy to the approval department after submitting the application

Please upload a copy of your articles of incorporation:

Company Contracts/Work Agreements/Warranty

14. Do you have a copy of your company contracts with warranty information on your computer available for upload?

Yes

No - I will email/fax a copy to the approval department after submitting the application

Please upload a copy of your company agreement/contract with warranty information

Company Insurance Information

15. Do you carry both General Liability Insurance and Workers Compensation Insurance? *

Yes

No - We do not have any employees

15a. Is your General Liability Insurance and Workers Compensation Insurance both provided by the same insurance agent/agency? *

Yes

No - Separate Agents/Agencies

Workers Comp & General Liability Insurance Information

15b. Insurance Agent/Agency Name *

15c. Insurance Agent/Agency Phone Number *

(At no cost to you) Please list "Phase One Marketing, LLC" as a Certificate Holder on your insurance

Download certificate holder request form to email/fax directly to your insurance agent. Choose a format below.

Certificate Holder Request Form PDF | Certificate Holder Request Form Word

Workers Compensation Insurance Agent/Agency

15b. Workers Compensation Insurance Agent/Agency Name

15c. Workers Compensation Insurance Agent/Agency Phone Number *

(At no cost to you) Please list "Phase One Marketing, LLC" as a Certificate Holder on your insurance

Download certificate holder request forms to email/fax directly to your insurance agents. Choose a format below.

Workers Comp Certificate Holder Request Form PDF | Workers Comp Certificate Holder Request Form Word

General Liability Insurance Agent/Agency

15d. General Liability Insurance Agent/Agency Name *

15e. General Liability Insurance Agent/Agency Phone Number

(At no cost to you) Please list "Phase One Marketing, LLC" as a Certificate Holder on your insurance

Download certificate holder request forms to email/fax directly to your insurance agents. Choose a format below.

General Liability Certificate Holder Request Form PDF | General Liability Certificate Holder Request Form Word

Customer References

Please list 5 past references. 1 or 2 for each year for the past 3 to 5 years.
Please include customer name, phone number, and date work was performed

16a. Customer Reference #1 *

16b. Customer Reference #2 *

16c. Customer Reference #3 *

16d. Customer Reference #4 *

16e. Customer Reference #5 *

Website Listing Information

Company Listing Name

17. Enter Company Listing Name EXACTLY as you would like it to appear:

Website Listing(s)

18. Please choose each website you would like to list your company as a member and receive leads from: *

AllAboutDriveways

AllAboutParkingLots

Patios And Walkways

Although PatiosAndWalkways.com is not currently live, renewing members will be grandfathered in to this website once it goes live.

Regions/Territories

19. Please select the State and regions you would like to list your company *

State(s)

Region(s)

Please select state to display the regions

Don't see your city or county on the list?

20. Would you like to suggest cities or counties we should add to our website?

Yes

No

20a. Please suggest a city and or county to add to your listing *

*

21. Do You Operate In More Than One State?

Additional States?

Yes

No

22a. Please list additional states:

Category Listings

21. Please choose the main category you would like to list your company: *

21a. Main Category Listing *

Please list a secondary category you would like to list your company: *

21b. Secondary Category Listing *

22. Would you like additional category listings? *
(Asphalt, Concrete, Permeable Pavers, Gravel or Grading, Striping/Marking, Sweeping, or Snow Removal?)

Yes

No

22a. Please select any additional categories you would like to list your company:

* If available. Categories are limited to 3 Companies, Per Category, Per Region. If a category is full, approved members will have first right of refusal upon openings. The waiting list is on a first come first served basis.

Please be advised: You MUST perform at least 70% of the additional categories you choose "In House". We do not allow companies to sub-contract work to companies that are not approved by Patrick Mattingley.

Additional Category Listings *

Asphalt Installation

Asphalt Repair, Maintenance & Sealcoating

Concrete Installation

Concrete Repair, Maintenance, Sealing & Overlays

Gravel Installation, Maintenance & Grading

Paver Installation and Maintenance

Striping/Marking

Estimate Request Notifications

All estimate requests are emailed to you automatically once a visitor has confirmed their request for an estimate

23. Please indicate the MAIN email address where all estimate requests should be sent to: *

24. Would you like more than one person within your company to receive a copy of all email estimate requests? *

Yes

Attention: Requests cannot be sent to anyone outside of your company. Email address must be company email address.

24a. Please select all that apply: *

Applicant/Owner 2

Office Manager

Sales Manager

Estimator

Estimator 2

Applicant/Owner 2 Name *

Applicant/Owner 2 Email *

Office Manager Name *

Office Manager Email *

Sales Manager Name *

Sales Manager Email *

Estimator Name *

Estimator Name *

Estimator 2 Name *

Estimator 2 Email *

Membership Emails

We send monthly and occasional emails with important information about your membership as well as valuable business building tools:

- Online and offline marketing secrets to help you grow your business!
- Sales secrets to help you get more signed proposals!
- Plus many more business building tools!

The main company email address is required to be on this email list.

25. Would you like company management, sales managers, or estimators to receive membership emails? *

Yes

25a. Please select all that apply: *

Applicant/Owner 2

Office Manager

Sales Manager

Estimator

Estimator 2

Membership Agreement

This agreement is made and entered into by and between PHASE ONE MARKETING, LLC, a Colorado Limited Liability Company (referred to in this agreement as "Phase One Marketing, LLC") and

(referred to in this agreement as "Company") for the purpose of listing "Company" on any of the Phase One Marketing, LLC websites and any additional products and or services purchased from Phase One Marketing, LLC. This agreement is considered as a total agreement, in summary according to the Membership Agreement/Terms And Conditions

Company understands they are purchasing the service area regardless of how those boundaries are identified. This is the service area that will be used on the internet.

"Company" refers to the above company name and if required is licensed by a city or county in

Or by the State of:

and hereby certifies license and insurance is active and valid at the time of this agreement.
Company is established and holds all local and state permits and licenses required for the formal performance of: (If Required)

IN WITNESS WHEREOF, for adequate consideration and intending to be legally bound, the parties hereto have caused this Agreement to be executed by their duly authorized representatives. I UNDERSTAND ANY MARKETING AND/OR ADVERTISING IS NOT A SCIENCE; THAT IT IS A CREATIVE PROCESS WITH ASSOCIATED RISKS, AND THAT THERE ARE NO GUARANTEES OR WARRANTIES (EXPRESSED OR IMPLIED BY PHASE ONE MARKETING OR ITS AFFILIATES AS TO THE NUMBER OF CALLS, WEB HITS, LEADS OR INCOME TO THIS PROGRAM AND/OR ROI, NOR WILL THIS BE A REASON TO REQUEST A REFUND.

Membership Agreement/Terms And Conditions

27. Who is submitting this Company Profile and Agreement? *

Owner

Employee of Company on behalf of owner

27a. First and Last Name *

27b. Please enter your company email address *

Copy of submitted application will be sent to this email address

Terms and Conditions *

I have read and agree to the Membership Agreement/Terms And Conditions

Contractors You Can Trust!

Asphalt Repair, Maintenance & Sealcoating

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