Builder Program Inquiry 1. Company Information Contact Name: Title: Business Name: Business Address: City: State: Zip: Business Phone: Fax: E-mail Address: Web Page: 2. Type of Business Business Type: Realtor Builder Developer Dealer Other if other, explain: Ownership: Proprietorship Partnership Corporation Other if other, explain: Date Established: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / Full Time Employees: Part Time: 3. Submit Inquiry Upon receipt of this information, Westchester Modular Homes will review your submitted information and contact you regarding the Independent Builder Program.

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