Northern NE Contractor Application

Air Conditioning Association of New England

Northern New England Chapter

Contractor Membership Application Form

Contractor: Contracting firm, corporation, or individuals who design, install, service and/or repair environmental systems such as heating, air conditioning, refrigeration, humidification, air purification, and ventilation.

MEMBERSHIP INFORMATION:

Company

Mailing Address

Street/P.O. Box

City * State * Zip Code *

Phone

Website

Shipping Address (if different)

Street

City State Zip Code

Key Contact

Title

Cell

Yes, I wish to serve on the ACA/NE Northern New England Chapter Leadership Group.

Alternate Contact

Title

Cell

Yes, I wish to serve on the ACA/NE Northern New England Chapter Leadership Group.

Did an ACA|NE member tell you about the Association? If so, please provide their name and company.

Name:

Company:

MEMBERSHIP DEMOGRAPHICS:

Types of Work Performed:

AC Air Conditioning	CN Controls	DC Duct Cleaning	EL Electrical
EM Energy Management	HT Heating	IL Insulation	IA Indoor Air Quality
PB Plumbing/Piping	RE Refrigeration	SM Sheet Metal	VT Ventilation
AA All listed	Other _______________

Fields of Work Performed:

(Please provide the percentage of your work that is performed in each of these areas)

Design Build

Residential Institutional Government

Commercial/Industrial

Light Commercial Industrial

MEMBERSHIP PAYMENT:

Membership is based on the number of employees at this location - please check one:

Total Employees = Dues:

1-3 Employees, Dues= $500	4-9 Employees, Dues=$600
10-24 Employees, Dues= $700	25+ Employees, Dues= $800

Total Fees

Payment Check Master Card VISA American Express

As a member

I agree to abide by the ACA/NE Code of Ethics.

Payment Options

I agree to allow ACA/NE to use my credit card to pay my annual membership dues.

Preferences

All at once Monthly Quarterly Twice Per Year

Account Number

Postal Zip Code

Security Code

Expiration Month Expiration Year *

First Name

Last Name

Cardholders's Email

ACA/NE dues are not deductible as a charitable contribution for federal taxes, but may be deductible as a business expense up to 62%.

ACA/NE | 11 Robert Toner Blvd., # 234 North Attleboro, MA 02763 | Phone: 508-839-3407 | Fax: 508-232-6005 | katie@acane.org

ACA/NE and ACA/NNE are not a part of, or affiliated with ACCA, which is a national association.