application for industry partner

Company Information
Company Name
Street Address	Street
	City	State	Zip
Mailing Address	Street
	City	State	Zip
Telephone		Fax
Other Phone
E-Mail
Years in Business		Type of Business

Contact Information
Primary Contact Person		Primary Title
Alternate contact person		Alternate Title

Membership Information
Type of Membership
$3,200 Gold Industry Partner (Distributors only) -A firm whose products and services are aligned or allied to the electrical contracting business. $1,500 Silver Industry Partner -Invited by the Board to join the Association who specializes in fields deemed appropriate.

Company Bio
Provide concise information, inclusive of dates, of company’s origination, business experience, primary type of work performed, specializations, etc.


Sponsor Information
Applicants must be sponsored by two (2) IEC-Florida West Coast Chapter Contractor Members in good standing.
Member Sponsor 1:		Member Sponsor 2:

Signature
Signature	Title	Date

Company Information