NJ PHCC Member App 2015[2] - New Jersey Plumbing, Heating

New Jersey PHCC Membership
Application
Payment options
o Annually
(only option for Intro.
Rate)
o Active Member Regular: $795
o Bi-Annually
(National & State Dues included; local dues extra)
o Introductory Membership:$552.00
o Quarterly
(Dues must be paid in full for the year to qualify for Introductory
rate.includes National & State, additional fee for local if applicable)
o Monthly
Please note: All installment dues payments, i.e. semi-annually,
quarterly or monthly, will incur a 2.4% service charge.
____________________________________________________________________
Contact Name
Title
__________________________________________________________________________
Company Name
Company Website
PHCC membership dues
are not deductible as a
charitable contributionfor
U.S. Federal income tax
purposes, but may be
deductible as a business
expense
__________________________________________________________________________
Company Address
City
State
Zip
Mission Statement:
PHCC is dedicated to the
promotion,
advancement, education
and training of the
industry for the
protection of our
environment and the
health, safety and
comfort of society.
__________________________________________________________________________
Home Address
City
State
Zip
__________________________________________________________________________
Home Phone
Email
Business Phone
Business Fax
__________________________________________________________________________
Spouse Name
License #
DOB
Method of payment:
o
o
o
Check Enclosed
Credit card
Request invoice for online payment
(please provide email address to send
invoice)
Type of CC Card: ⃝ Visa
⃝ MC
⃝ Amex
⃝ Discover
CC #____________________________________ EXP_______
CVV________
Name on Card_________________________
Credit Card Billing Address::
___________________________________________________
Keep You and Your Business Healthy with one of your NJPHCC
Member Benefits:
•
•
•
•
•
Access to medical and dental plans that provide coverage through Horizon Blue
Cross Blue Shield of New jersey and Delta Dental Plan of New Jersey
Core medical products include PPO plans and a remarkable POS plan.
No primary care physician (gatekeeper) requirement or referral hassle
Extremely competitive pricing that may offer some of the lowest rates in NJ.
The NJPHCC is the only state trade association servicing all sectors of the plumbing,
heating and cooling industry. Formed in 1902 the NJPHCC is affiliated with the
Plumbing-Heating-Cooling-Contractors National Association, and has local affiliates
throughout the state.