EmailMe Form - Contractor Membership Program

EmailMeForm

Select an Option
Category 1 (1-5 Employees | $35 weekly)
Category 2 ( 6-10 Employees | $45 weekly)
Category 3 (11-20 Employees | $60 weekly)
Category 4 (21-60 Employees | $85 weekly)
Category 5 (61-100 Employees | $125 weekly)
Category 6 (101-150 Employees | $180 weekly)
Category 7 (151-200 Employees | $225 weekly)
Category 8 (200+ Employees | $295 weekly)
Employees include foremen, journeymen, registered apprentices, other apprentices, helpers, and laborers in the area).
Company name *
Company Phone Number *
### - ### - ####
Business Fax
### - ### - ####
General Business Email (i.e. admin@iecfwtc.org) or your main/default email for invoicing, communications, etc. *
This email address will receive all billing notifications.
Business Website *
Business Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Would you like to receive emails about IEC FWTC events and news?
Yes
No
Contact Information
Name of Primary Contact *
First Last
Primary Contact Title *
Primary Contact Email *
Primary Contact Business Phone *
### - ### - ####
Primary Contact Business Cell *
### - ### - ####
Primary Contact # of years in trade
Name of Alternate Contact *
First Last
Alternate Title *
Alternate Contact Email *
Alternate Contact Business Phone *
### - ### - ####
Alternate Contact Cell Phone
### - ### - ####
About Your Company
What is the primary office location of your company? *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Please list any additional locations (headquarters, administration, or satellite locations)
Texas Electrical Contractor License?
Yes
No
Texas Electrical Contractor License Number
Master Electrician Name *
Master Electrician License #
Do you anticipate sending your apprentices to school? *
Yes
No
Do you bid on Davis-Bacon / Government Contracted Projects? *
Yes
No
Do you have an internal safety program in place?
Yes
No
About Your Work
Why are you interested in joining this association?
Please select the categories of work projects your company engages in:
Residential
Commercial
Light Industrial
Industrial
Heavy Industrial
Institutional / Municipalities
Low Voltage
High Voltage
Utilities
Energy / Renewable Energy
Highway/Transportation
Please select the Building Components & Services your company has installed:
Maintenance / Service / Repair Only
Maintenance / Service / Repair
Design / Build Services
Pre-fabrication / Manufacturing
Premises Wiring
Alternative energy systems (Solar, Wind, EV charging)
LED lighting retro-fit and design
Power Quality Systems (Standby, Co-gen, etc.)
Security (includes CCTV, Access / Motion / Intrusion Systems)
Fire Life Safety Systems
Total Building Automation Systems (HVAC, Lighting)
Fiber Optics
Communication Systems (Voice / Video / Data)
Other
How did you hear about IEC FWTC membership? Who can we thank for referring you?
References
Electrical Contractor (Name, Address, Phone)
Customer (Name, Address, Phone)
Supplier (Name, Address, Phone)
Payment Information
Please select your payment type below. All information is securely stored.
Payment Type
Credit Card
Check
Please enter credit card information below, which is stored in a secure location.

For checks, please make checks payable to: IEC
Mail to: 5809 E Berry St., Fort Worth, TX 76119
Payment Amount
$ Dollars . Cents
Credit Card

Card Number

Protected in vault Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
Completion
Membership shall be continuous. In the case of termination, all dues and fees shall be paid in full as of that date and I agree to discontinue immediately the use of the Association insignia in any form. This application is subject to approval of the Board of Directors.

I authorize investigation of all statements contained herein and certify they are true and correct and hereby make application for contractor membership.
Signature
Clear
Text List

Signed by:

Title:

Date:

Signed by:
Title:
Date:

Contact Information

About Your Company

About Your Work

References

Payment Information

Completion