• Company Information

  • Safety

    Safety is very important at Staley. Please answer the following questions completely.

  • **Note** Staley Inc., retains the right to request a copy of your safety plan and receive it in a timely manner.

  • General Information

  • Date Format: MM slash DD slash YYYY
  • Experience

  • Please check the following items field technicians have onsite:
  • Legal Issues

  • Project Deadlines

  • References

    Provide three References (Owner, Architects, or General Contractors for work completed within the last 2 years): (REQUIRED)

  • Rates

    All fields are required.

  • Licenses

    Contractor’s License(s) States and Numbers (if applicable):

  • Just Curious

  • Signatures

    I hereby certify that the above information is accurate, correct and true.

  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.