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Contact Insurance Workers' Comp Carrier Expires Liability Carrier Expires License Has your Contractor's License ever been revoked?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 If yes, please explain . . .

Please print this page and mail it -- along with your dues check -- to: PCASC Executive Director 2402 Vista Nobleza Newport Beach, CA 92660 Thank you.