Company name
Phone
Address
City
State
Zip Code
Email
Contact Person(s) for news, notifications, and updates: FOR CONTRACTORS ONLY- please fill out all that apply
WA Contractor License #
Idaho HVAC Contractor License #
Additional State Contractor License #
Please Check One: HVAC/R General Contractor Membership (open annually/ 12 months)HVAC/R Registered Dealer Network Membership (Jan thru Dec) (Applicant will also be sent a supplemental RDN application and meet additional standards)Utility/Affiliate Membership (annually/ 12 months) (electrical utilities, educational institutions/ districts, hospitals, building maintenance departments,architects, engineers, and other interested individuals). *gas utilities vary by customer base.Wholesaler/ Manufacturer Membership (annually/ 12 months)Branch: each additional (annually/ 12 months) – inquire with office on discounts (manufacturers, wholesalers)
Payment Method Check (mail to: Northwest HVAC/R Association, 204 E. Nora Ave, Spokane, WA 99207)Send InvoiceCredit Card (we will call you to collect the necessary information)
Authorizing Representative Name Authorizing Signature
Date
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