GUCA Utility Contractor Mid-Year Membership Application

GUCA Utility Contractor Mid-Year Membership Application

Use this Membership Application if your company performs utility contracting as a primary means of business as defined by the Georgia Utility Contractors Licensing Law.To apply for Utility Contractor membership please complete all questions. This is to apply for Utility Contractor Membership and pay the required Dues. Please note: Membership dues are currently half price and will cover membership for the remainder of the year.
Company Name *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Company Phone Number *

Area Code Phone Number
Company Fax Number

Area Code Phone Number
Type Work *
GA Utility Contractors License #
Website
Contact Name *

First Name Last Name
E-mail *
Cell Number

Area Code Phone Number
Signature
Signature date
Recrutied By:

Full Name Company
Officer of Company

First Name Last Name Title
E-mail
Officer of Company

First Name Last Name Title
E-mail
Officer of Company

First Name Last Name Title
E-mail
Officer of Company

First Name Last Name Title
E-mail
Utility Contracting Volume and Mid-Year Dues Amount-Choose One *
prev next ( X )
$0-$2 Millon Yearly Volume $ 600.00

$2-$5 Million Yearly Volume $ 1,200.00

$5-$10 Million Yearly Volume $ 1,600.00

Over $10 Million Yearly Volume $ 1,900.00

Subtotal $ 0.00 Shipping $ 0.00 Total $ 0.00
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