Contractor Membership Application

The applicant agrees with the stated principles of this Association and agrees to abide by the Rules and Regulations as proclaimed in its Charter and By-laws, and authoritative actions of its Board of Directors. Membership will be continuous, and applicant agrees to pay all membership dues, contractor fees ($300 per apprentice per semester) , and assessments fees when due. This application is subject to the approval of the IEC of Southern Arizona Board of Directors.

* Today's Date MM/DD/YYYY

* Company Name

* Company Website

* Office Number

Fax If applicable

Primary Contact

* Title

* First Name

* Last Name

* Email

* Phone Number Indicate if work or cell

* Date of Birth

Secondary Contact

* Title Write N/A if not applicable

* First Name Write N/A if not applicable

* Last Name Write N/A if not applicable

* Email Write N/A if not applicable

* Phone Number Write N/A if not applicable. Indicate if work or cell

* Date Of Birth Write N/A if not applicable

Physical Address

* Address

* City

* State

* Zip

Mailing Address

(If Different)

Address

City

State

Zip

* Is the mailing address commercial or residential?

Commercial
Residential

Professional Information

* Has your license ever been suspended or revoked?

Yes
No

If yes, please explain

* Years in business

* Years in electrical trade

References #1

* Electrical Contractor

* Address

* City

* State

* Zip

REFERENCES #2

* Electrical Contractor

* Address

* City

* State

* Zip

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Contractor Membership Application

Primary Contact

Secondary Contact

Physical Address

Mailing Address

Professional Information

References #1

REFERENCES #2

Company Information