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
test@fdicreative.com test test test test TX test Acknowledge 69c6b10bdf4e4-00-regas-about.png #CENTRAL TEXAS|#EAST TEXAS 09-130 2026-03-27 16:32:11
heather@fdicreative.com 11111 houston 77070 TX TEST Acknowledge 69c6afb0ea34f-00-regas-about.png #CENTRAL TEXAS|#EAST TEXAS 09-130 2026-03-27 16:26:24
lindsay@regas.com 5050 Materials Only Sugar Land 12345 TX NONE Acknowledge 69c6a69ab228e-Form W9.pdf 09-250|09-986|07-200|OTHER ACM Panels 2026-03-27 15:47:38
lindsay@regas.com 9999 Supplier Road Sugar Land 77479 TX 69c6a23cd4934-WBE Exp 11.1.26.pdf Change Bank/Regas Contracting Acknowledge 69c6a23cd6d8d-Form W9.pdf #CENTRAL TEXAS|#EAST TEXAS 16-050|16-050 Wiring 2026-03-27 15:29:00
lindsay@regas.com 1234 Material Lane Houston 77777 TX Chick-fil-A/Regas Contracting Panda Express/Regas Contracting Acknowledge 69c6a0fe00f39-Form W9.pdf #ALL TEXAS 10-800|10-600 2026-03-27 15:23:41

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