PECA Membership Application
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.
NJ Weights & Measures Company Only License No.
NJ Underground Storage Tank Certification License No.
Installation - Check all items you are licensed for.
Entire UST System
Release Detection Monitoring System Only
Closure
Tank Testing
Substance Evaluation
Corrosion Protection System Analyst
Cathodic Protection Specialist
Cathodic Protection Tester Only
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.
Advertising Education and Safety
NJ Government Affairs/B.U.S.T. Membership
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 07871

Phone  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.

Thank you for your desire to join the

Petroleum Equipment Contractors Association
of New Jersey
PECA Membership

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