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SOME BASIC INFORMATION
Company Name
*
Address 1
*
Postal Code
City
*
Province
*
Email Address
*
Confirm Email Address
*
Phone
*
Fax
Web Site
Principal Owner
*
Contact Name
*
And if different from company information above:
Phone #
*
Fax #
*
YEARS IN BUSINESS
Quinte Area
*
Outside Quinte Area
IF ANOTHER AREA
Company Name
Address
PC
Phone #
Fax #
Relationship to current business
Member of Other Builders' Association?
Description of Business
Builder/Renovator
Carpet/Flooring
Education
Equip/Rent/Supply
Homecare Services
Interior Decorating
Landscaping
Plumb/Heat/Air
Real Est/Develop
Vacuum Systems
Water
Bldg/Materials
Communications
Electrical
Financial
Insulation
Kitchen/Bath
Legal Services
Pools/Spa
Shelving/Storage
Utilities
Vinyl/Alum Prod.
CURRENT QHBA MEMBER SPONSORSHIP (*must be completed*)
SPONSOR CONTACT NAME
*
SPONSOR COMPANY NAME
SPONSOR TELEPHONE:
CREDIT INFORMATION
FINANCIAL INSTITUTION
NAME OF FINANCIAL INSTITUTION
*
ADDRESS OF FINANCIAL INSTITUTION:
CITY & POSTAL CODE
*
NAME OF FINANCIAL INSTITUTION CONTACT PERSON:
FINANCIAL INSTITUTION TELEPHONE #:
*
SUPPLIER/SUB TRADES REFERENCES
REFERENCE #1 -COMPANY NAME:
REFERENCE #1 -COMPANY ADDRESS
*
REFERENCE #1- CITY & POSTAL CODE
REFERENCE '#1 - CONTACT PERSON:
REFERENCE #1 -TELEPHONE
*
REFERENCE #2 - COMPANY NAME:
*
REFERENCE #2 -COMPANY ADDRESS
REFERENCE #2- CITY & POSTAL CODE
*
REFERENCE #2- CONTACT PERSON:
REFERENCE #2 -TELEPHONE
*
IF BUILDER
Tarion #
Number of Units Built in current year
*
Number of Units completed in current year
I agree with and will be bound by QHBA's Code of Ethics
*
Yes
No
Code of Ethics
I agree with the Protection of Privacy Statement.
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Privacy Statement
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