Lux Business Center - Registration

General Builder Information

Business Name:

Street Address:

Province:

City/Town:

Postal Code:

Email:

Phone:

Fax:

Cell:

Website:

Types of work:

Homes

Condos

Renovations

Please select one: Type Of Business

Select All That Apply:

Incorporated Company

Joint Venture

Developer

Foundation Contractor

Project/Construction Manager

Limited Partnership

Partnership

Sole Proprietorship

General Contractor

Other:

Company Principal/Director

Title:

Address:

DOB:

Name:

License #:

Phone #:

Second Company Principal/Director (if applicable)

Title:

Address:

Name:

Phone #:

Other Company Principal/Director (if applicable)

Title:

Address:

Name:

Phone #:

Have you or have your shareholders or principals ever been bankruapt or in receivership proceedings?

Yes No

Have you or have your shareholders or principals ever been registered with a new home warranty program?

Yes No

Please identify three of your suppliers / sub-trades:

Supplier 1 Information

Company:

Contact Person:

Phone:

Supplier 2 Information

Company:

Contact Person:

Phone:

Supplier 3 Information

Company:

Contact Person:

Phone:

Please identify three: Customers of new homes or Significant renovations:

First Customer

Name:

Address:

Phone #:

Second Customer

Name:

Address:

Phone #:

Third Customer

Name:

Address:

Phone #:

Experience

Please provide a brief resume indicating your construction experience, any related education (Licensed carpenter, Engineer...) as well as, your future objectives in building.

By submitting this form by way of e-mail, fax or mail I authorize Lux Residential Warranty Program Inc to obtain such factual and investigative information regarding me from others as permitted by law and to furbish other credit grantors and any credit bureau, particulars of this credit application. In addition, I hereby acknowledge notice from Lux Residential Warranty Program Inc. that a consumer report containing credit information may or will be referred to in connection with this application for credit or any renewal or extensions thereof.

Signature:

Net Worth Sheet

Personal Net Worth Statement Of:

Assets

CASH:

STOCKS (GIC/RRSP):

REAL ESTATE:

AUTO:

OTHER:

TOTAL ASSETS:

NET WORTH:

Liabilities

TAXES:

LINES OF CREDIT:

MORTGAGE:

AUTO:

OTHER:

CREDIT CARD

TOTAL LIABILITIES:

Are you a Guarantor of any other debts?
Yes No
Provide Details:

Are there any law suits or judgement against you?
Yes No
Provide Details:

Have you declared bankruptcy?
Yes No
Provide Details:

BUILDER AGREEMENT

You must download, print, fill out, scan, and email the builder agreement to info@luxwarranty.com before we can process your application.

CLICK HERE TO DOWNLOAD THE AGREEMENT

I have emailed the builder agreement

General Builder Information

Please select one: Type Of Business

Company Principal/Director

Second Company Principal/Director (if applicable)

Other Company Principal/Director (if applicable)

Please identify three of your suppliers / sub-trades:

Supplier 1 Information

Supplier 2 Information

Supplier 3 Information

Please identify three: Customers of new homes or Significant renovations:

First Customer

Second Customer

Third Customer

Experience

Net Worth Sheet

Assets

Liabilities

BUILDER AGREEMENT

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