GUCA Associate Affiliate Membership Application
Use this Membership Application if your company is a supplier, attorney, accountant, insurance agent, equipment dealer or other vendor that supports and services the underground utility construction industry. This does not include any company that performs contracting services on a jobsite.
Company Name
*
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Company Phone Number
*
-
Area Code
Phone Number
Company Fax Number
-
Area Code
Phone Number
Type of Work
*
Sales
Manufacturer
Rental
Insurance Services
Legal Services
Accounting Services
Financial Services
Safety/Training Services
IT/Technology Services
Marketing Services
Environmental Services
Other Services
Description of sales, rental, manufacturer and other services
Website
Main Contact
*
First Name
Last Name
E-mail
*
Cell Number
-
Area Code
Phone Number
Signature
Signature date
Company Officers
*
Associate Member:Annual Sales Volume and Dues Amount-Choose One
*
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( X )
$0-$2 Million Yearly Volume
$
800.00
$2-$5 Million Yearly Volume
$
1,200.00
Over $5 Million Yearly Volume
$
1,500.00
Subtotal
$
0.00
Shipping
$
0.00
Total
$
0.00
Recruited By GUCA Member:
Full Name
Company
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*
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