Application for Membership

Please fill in all spaces - Applications sent with missing information cannot be processed.

Company Information
Company Name
Main Contact
Street Address
City
State
Zip Code
Phone
Fax
E-mail
Web Site

 

Dues (please check one)
$300
Plastering Contractor - 1 to 15 employees
$400
Plastering Contractor - 16+ employees
$400
General Contractor and/or Developer
$400
Supplier/Manufacturer/Rep

 

Business Reference #1
Company
Contact
Address
Phone
Business Reference #2
Company
Contact
Address
Phone
Business Reference #3
Company
Contact
Address
Phone

 

Bank Reference
Branch
Contact

 

Insurance
Workers' Comp Carrier
 Expires
Liability Carrier
 Expires

 

License
Has your Contractor's License ever been revoked?
Yes No

Your application will be complete as soon as we receive
your Dues check, in the mail.

Thank you.
info@plasteringcontractors.org
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