MembershipApplication
Mail To: Date:____/____/____
Dana
Quigley
Bristle
Chimney Sweeps, Inc.
921
Walsh Rd, Suite 210
Madison,
WI 53714
(608)
249-6678
Current Dues: $75.00
Business Name: |
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Owners Name: |
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Address: |
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City: State: Zip: |
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Phone: |
Fax: |
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Email: |
Website: |
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How long have
you been in business? Full or Part time?
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Do
you have another occupation? |
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Are
you a member of any other business organizations? |
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Do
you hold any certifications or licenses?(If yes, please give expiration dates
if applicable.) |
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Have
you attended any chimney seminars? |
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What
type of cleaning equipment do you own? |
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How
many vehicles do you have on the road? |
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Who
is your business liability carrier and the amount of coverage? |
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How
many employees do you have? |
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What
type of services do you offer? |
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Office
Use Only: Accepted/Rejected
Date:___/___/____
Reason:______________________________________________________________________ Full Membership ______
Associate Membership_____
Newsletter Only_____ Yearly Fees that apply_________________ Other Notes:_________________________________________________________________________________ |