IEC Contract Member Application Form
Questions? Email Lexie Kabb, Membership Coordinator, akabb@ieckyin.org or call Lexie at 502-493-1590, option 3.
Company Name
*
Company Website
*
Main Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Billing Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business License Issue Date
*
-
Year
-
Month
Day
Date
Years in Business
*
Kentucky CE/ME License #
*
What type of work does your company provide?
Please Select
Residential
Commercial
Industrial
Maintenance Electricians - Onsite
Number of Electrical Field Employees
*
1-5
6-10
11-20
21-60
61-80
81-100
101-150
Main reason for applying for membership
*
Please list at least two business references, including name, company name, and phone number
*
Is there anything about your business that you feel we should know while reviewing your application?
Submit
Should be Empty: