APPLICATION FOR MEMBERSHIP

Somerset County Builders Association

Date __________________________                  Contractor Registration # (if applicable)                 

From _______________________________         Title __________________________________

Company ___________________________         Phone (            )_________________________

Type of Business ____________________          E-mail Address _________________________

Business Address _____________________________________________________________

No. of Continuous Years Experience               Membership Class       _______  Builder

in Our Company’s Field of Work          _____                                       _______  Associate

REFERENCES:  All blanks must be completed

BANK REFERENCE ____________________________________________________________

Address _____________________________________________________________________

Phone (          )______________________          Contact Person _________________________

SUPPLIER (TRADE) REFERENCES:

1. ___________________________________________________________________________

Address _____________________________________________________________________

Phone (        )­_______________________           Contact Person _________________________

2. ___________________________________________________________________________

Address _____________________________________________________________________

Phone (         )______________________           Contact Person _________________________

CUSTOMER (PERSONAL) REFERENCES:

1. ________________________________            Phone (         )___________________________

Address _____________________________________________________________________

2. ________________________________            Phone (         )___________________________

Address _____________________________________________________________________

     I agree to abide by the constitution and by-laws of the Somerset County Builders Association and of the Pennsylvania Builders Association and the National Association of Home Builders of the United States, with which it is affiliated.

      A remittance of $  380.00  , representing my annual membership dues in the Somerset County Builders Association and the affiliated associations accompanies this Application.  Of the amount remitted for annual dues, $10.00 is for a subscription for one year to Builder magazine and $10.00 for a one year subscription to NAHB News.

                                                                                                Name of Sponsor _______________________

_________________________________                              ______________________________________

Signature of Applicant                                                        Signature of Sponsor

Return this Application to:  Somerset County Builders Association,  P.O. Box 221,  Berlin, PA   15530

NOTE:  A certificate of insurance verifying workers’ compensation insurance (if required of your company by the laws of the Commonwealth of Pennsylvania) and third party liability insurance must accompany this application.