Brechbill and Helman

Dear Construction Industry Professional:

In an effort to keep our bidders list current, and determine the projects which are best tailored to your size and expertise, we would like you to take a few minutes to complete the following company resume for our files.

Company Name:
Mailing Address:
UPS Address (if different from above):

Phone:
Fax:
E-Mail:
Website Address:

Registered Minority Business Enterprise: Yes No

If yes, Registration #

Number of years your firm has been in business: years

Approximate distance you are willing to travel one way: miles

Name, dollar value and person of contact for recently completed projects:
Name, dollar value and person of contact for current projects:

Number of employees currently on payroll:

Can you be bonded? Yes No: If yes, Maximum Bonding Capacity: $

Will your suppliers require a joint check agreement? Yes No

Please state your primary trade of work:

Please list any secondary trades of work for your company:

Please provide the following state and local license numbers (if applicable):

Pennsylvania
Maryland
Virginia
West Virginia

Due to the recent change in FCC (Federal Communications Commission) law, we need your permission in order to send you information via fax (Invitations to Bid, Addendums, etc).
Do we have your permission: Yes No

If you desire, you may send any additional company information to:

Brechbill & Helman Construction Company, Inc.
Attn: Pam Ridenour
1115 Sheller Ave
Chambersburg, PA 17201

If you have any questions, please feel free to contact Pam Ridenour at (717) 263-4621.

Form completed by:
Title:
Today's date: