EmailMe Form - NC-PC DUES

INVOICE

Date of Invoice: January 13, 2018
Due Date: March 15, 2018
NC-PC Tax ID # 56-2175365

DESCRIPTION
NC-PC dues for the year 2018 as per Article 4 of the NC-PC By-Laws: $25.00

TOTAL DUE: $25.00

Name *

Prefix First Last Suffix

Pretreatment Program *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Email *

Member of NC-PC since: *

(List Year, Example 1997)

Please select the type of Payment you would like *

Credit Card

Check

Credit Cards: (Please print payment confirmation and include with registration form)

Checks: (Make checks payable to NC Pretreatment Consortium)

MAIL TO:

North Carolina Pretreatment Consortium, Inc.
P.O. Box 40117
Raleigh, NC 27629-0117

Credit Card Confirmation

Attach The PayPal Confirmation Page

Note: As amended in the By-Laws during the year 2000, dues are payable for each member. If one of
your pretreatment personnel did not receive an invoice, copy this invoice and complete information.

Important: Please ensure the remittance slip is enclosed with the check so proper credit can be determined.

Checks Payable to: North Carolina Pretreatment Consortium, Inc.
P.O. Box 40117
Raleigh, NC 27629-0117