Company Name Office Phone Number Company Email Address Address City Zip State Is your company currently a Certified Diversified Business (ex: MBE, WBE, SBE, etc.)? Please attach copies of Diversity Certificates here Project Experience in the last three years A current Certificate of Insurance indicating General Liability and Workers Compensation coverage must be provided to Regas Contracting prior to any contract issuance. If you do not carry Workers Compensation insurance, a waiver is acceptable. Please attach a copy of your W-9 Type of Services Offered Shipping/Delivery Areas Shipping/Delivery Texas Areas Material Supplier of: Project Types Please select from the work locations below Texas Regions Trades Select Acoustics Trades Select Building Finishes Trades Select Flooring Trades Select Masonry Trades Select Metals Trades Select Millwork & Countertops Trades Select Plumbing Trades Select Site Utilities Trades Other Trades First Name Last Name Email Address Estimator Phone Number Should this contact be used for any of the other following communications? First Name Last Name Email Address Phone Number Please select the type(s) of communications for this contact to receive. First Name Last Name Email Address Phone Number Please select the type(s) of communications for this contact to receive. First Name Last Name Email Address Phone Number Please select the type(s) of communications for this contact to receive. Additional Comments Date Submitted Actions
FDI Creative +15555555555 heather@fdicreative.com 11111 houston 77070 TX no test Acknowledge 69cb1e2dde554-Chick-fil-A.jpg Supplier Texas|#ARIZONA|#LOUISIANA #ALL TEXAS 08-100|16-050|OTHER test test Heather Hatton heather@fdicreative.com +15555555555 Admin Heather Hatton heather@fdicreative.com +15555555555 Admin test 2026-03-31 01:06:53
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