PECA Membership Application | |||||||||||
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Company Name | |||||||||||
Mailing Address | |||||||||||
City State Zip | |||||||||||
Representative | |||||||||||
Alternate Representative | |||||||||||
Phone Number | |||||||||||
Fax Number | |||||||||||
Email Address | |||||||||||
Website Address | |||||||||||
Business Entity | Individual Partnership Corporation | ||||||||||
Business Started (Mo./Date/Yr.) | |||||||||||
Years In Present Business Form | |||||||||||
Associate Membership Requirements | |||||||||||
List Type Of Business | |||||||||||
Relationship To Petroleum Equipment Installation Industry | |||||||||||
Type Of Membership Requested | Active Associate Mfg/Rep | ||||||||||
Active Membership -
Fill in all that applies. Use company License Number
Only.
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Installation
- Check all items you
are licensed for.
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Corrosion Protection System Analyst | |||||||||||
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Sponsors | |||||||||||
List two (2) existing PECA member companies' names you feel would sponsor your application. | |||||||||||
Sponsor #1 | |||||||||||
Sponsor #2 | |||||||||||
I would like to be considered for participation on the following committees. | |||||||||||
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List qualifications or expertise you posses that would enhance this Association. | |||||||||||
Applicant's Signature | |||||||||||
Type or Print Name | |||||||||||
Date | |||||||||||
Print Application
and Mail To:
PECA P.O. Box 1502 Sparta, NJ 07871Phone 973.729.2108 or FAX: 973.729.5441
Do not send a check with
this application.
Upon your acceptance, a letter will be sent along with a
prorated dues bill.
Petroleum Equipment Contractors Association of New Jersey |
