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Building and Industries Exchange of Pottstown -  Membership Application

Please print and complete the following form. Forward this form with payment in the amount of $450.00 ($100 one time entrance fee + one year's dues). Send To:

Building and Industries Exchange of Pottstown
801 North Charlotte Street
Pottstown, Pennsylvania 19464

 

Contact Name ______________________________________________
Company Names ______________________________________________
Company Address ______________________________________________
______________________________________________
City State and Zip ______________________________________________
Phone ______________________________________________
Fax ______________________________________________
Email ______________________________________________
Number of years in business ______________________________________________
Type of Business ______________________________________________
Banking References ______________________________________________

______________________________________________

______________________________________________
 

Business References ______________________________________________

______________________________________________

______________________________________________
 

Number of Employees ______________________________________________
 
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