Full Name
*
Email
*
Website
Today's Date
*
Company Name
*
(THIS NAME MUST MATCH THE NAME USED TO APPLY FOR WORKMAN'S COMP)
Address
Street Address
City
State
Country
Country
Postal Code
Office Phone
*
Cell Phone
*
Fax
Type of membership (builder members must provide Alabama Builder's License Number)
*
Builder
Associate
Builders License #
General Contractors License #
Electricians License #
HVAC License #
Plumbing License #
Primary Business Activity
*
Secondary Business Activity
*
List one category that you would like to be listed in MCHBA publications as
*
(To apply for additional businesses, multi business membership can be obtained for a fee of $50 per category)
Signature
*
Clear
Sponsor:
Do you have G/L Insurance?
Yes
No
If yes, with who?
*
Do you want W/C Insurance?
Yes
No