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Please print this form and mail to REPHCC
P.O. Box 750293
Petaluma, CA.
94975-0293
APPLICATION FOR CONTRACTOR MEMBERSHIP
I am a duly licensed
Plumbing, Heating and/or Ventilation contractor in Marin,Sonoma,
Napa, Solano and
/or Mendocino Counties and hereby make application to become a
member of the PLUMBING HEATING COOLING CONTRACTORS of the REDWOOD EMPIRE
and agree that if I am accepted and elected to membership, I will comply
with thebylaws
and rules of said Association.
Firm Name: _________________________________________________________________
Designated Representative: ___________________________________________________
Mailing Address: ____________________________________________________________
City/State/Zip: ______________________________________________________________
Phone: ___________________ Fax:____________________ E-mail___________________
Ca. Contractors License No. ________________________ Classification(s) _____________
Website Address: ____________________________________________________________
Home Address: ______________________________________________________________
City: __________________________ State:___________________ Zip:_________________
Spouse's Name: _____________________________________________________________
Recommended by: ____________________________________________________________
Dues: Payable monthly by automatic credit card charge or semi-annually
(in advance) by check.
| |
Local
|
State
|
National
|
Total
|
| 2 or less in field:
|
$40/mo.
|
$38/mo.
|
$34.47/mo.
|
$112.47
|
| 3 or less in field: |
$70/mo.
|
$38/mo.
|
$34.47/mo.
|
$142.47
|
Signature below indicates authorization to process monthly credit card
charges. Charges will continue until association receives 30 day written
advance notice of any request of change(s).
Circle one: Visa or MasterCard
Credit Card Number: ______________________________Exp. Date____________________
Name on Credit Card: __________________________________________________________
Cardholder Signature: __________________________________________________________
_____________________________________________________________________________
For Office Use
Only Approved by Board of Directors: Date ______________
President: _________________________________________Date_______________________
Secretary: _________________________________________Date_______________________
Director: __________________________________________Date_______________________
PHCC of Ca. notified____________(date)
NAPHCC notified ______________(date)