APPLICATION FOR WICA ACTIVE CONTRACTOR MEMBERSHIP Company Name Corporation Type Sole Proprietorship Partnership Corporation Street Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is Mailing Address the same as Street Adress? Yes, the same No, different Please add Mailing AddressMailing Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneFaxEmail State or Province Contractor License No. Class of License Name and Title of Authorized Representative(s):Name Title Name Title Name Title Name Title The above named company hereby makes application for active membership in the Western Insulation Contractors Association. Through this application, the undersigned approves of all Bylaws and Articles of Incorporation of the Western Insulation Contractors Association. The undersigned further approves the dues of the Western Insulation Contractors Association in the amount of four cents ($.04) per field employee per hour worked. This approval shall be effective on the date of this application, and thereafter until the amount of said dues is modified in accordance with the Bylaws and Articles of Incorporation of the Western Insulation Contractors Association. The dues of four cents ($.04) per field employee per hour worked are payable by the 20th of the month on work performed during the preceding calendar month. Checks should be made payable to the Western Insulation Contractors Association and mailed to 669 South 200 East, Suite 200, Salt Lake City, UT 84111. Minimum annual dues are $500.00. Signature of Company OfficialDate of Application MM slash DD slash YYYY For more information, please contact the WICA office at (801) 364-0050. Δ
