Apply to become a Licensed Installer

Company Information
Interested in Becoming a*
- Residential Thermocrete Installer
- Commercial Thermocrete Installer
- Thermocrete Licensed Agent
Company Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Mobile
Website
Company Type*
Tax ID # (Social Sec if applicable)*
Years in Chimney Business*
Please enter a value between 0 and 99.
Number of Employees*
Please enter a value between 0 and 99.
Personal Information
Owner(s) Name(s)*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Mobile
Email*
Customer Base Information
Description of Area Covered*
Number of Customers Current YTD*
Number of Customers Last Calendar Year*
Number of Customers Previous Year
Average Distance Traveled to Job (mi)*
Farthest Distance Traveled to Job (mi)*
Distance Willing to Travel*
References
Please List three (3) Professional References. These should be individuals and companies associated with our industry who have knowledge of you and your company.
Name or Company (1)*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email
Name or Company (2)*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email
Name or Company (3)
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Please List a Bank Reference
Bank Name*
Account #*
Cantact
First Last Position
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email
Describe briefly why you are interested in becoming a Thermocrete™ Installer and how it would fit into your total business plan:*
Please describe any previous work history, education or training that might be beneficial to you as a Thermocrete Installer.*
The information provided here is true and accurate to the best of my knowledge. I hereby authorize principals and agents of Ventech Industries to contact the companies and individuals listed above for the purpose of candidate selection. I also authorize Ventech to perform background checks on listed individuals. ALL INFORMATION PROVIDED WILL BE HELD IN THE STRICTEST CONFIDENCE AND WILL BE USED SOLELY FOR THE BENEFIT OF OUR SELECTION PROCESS
Signature*
Date*
Phone
This field is for validation purposes and should be left unchanged.

download here and return via mail, fax or email

Ventech Industries, Inc. 384 Harold L. Dow Hwy, Unit One Eliot, Maine 03903

fax: 207-439-0269 [email protected]

Apply to become a Licensed Installer

Company Information

Personal Information

Customer Base Information

References

Please List a Bank Reference