WEST TEXAS CHAPTER AGC, INC. Skill, Integrity, Responsibility General Contractor Membership Application Affiliate Date: Member Information Company Name: Mailing Address: Street Address: City/State: Zip: City/State: Zip: Phone: Cell: Fax: Website Principal contact person receiving West Texas AGC Chapter notifications: - contact email: Accounting email if different: Principal’s Email contact(s) for weekly Newsletter and Daily Updates: Email contact(s) for internet plan room invitations and notices: Company Background Date company established as a General Contractor List AGC Chapter Memberships and under what name: firm under this name: # of persons in the firm: Indicate if your company is: SBE (Small Business Enterprise) □ Of these: # of field employees: WBE (Women-Owned Business) □ MBE (Minority Business Enterprise) □ LBE (Large Business Enterprise) □ List type and scope of work the firm specializes in or services provided by your company: Classification CSI/UCI Code Primary: Alternate: Alternate: Company is a Corporation LLC Partnership Sole Proprietorship □ □ □ □ Principal Officers Name Title # of Years with Company
WEST TEXAS CHAPTER AGC, INC. Skill, Integrity, Responsibility Affiliate General Contractor Membership Application Date: Member Information Company Name: Mailing Address: Street Address: City/State: Zip: City/State: Zip: Phone: Cell: Fax: Website Principal contact person receiving West Texas AGC Chapter notifications: Principal’s - contact email: Accounting email if different: Email contact(s) for weekly Newsletter and Daily Updates: Email contact(s) for internet plan room invitations and notices: Company Background Date company established as a General Contractor firm under this name: List AGC Chapter Memberships and under what name: # of persons in the firm: Indicate if your company is: SBE (Small Business Enterprise) □ WBE (Women-Owned Business) □ MBE (Minority Business Enterprise) □ LBE (Large Business Enterprise) □ Of these: # of field employees: List type and scope of work the firm specializes in or services provided by your company: Classification CSI/UCI Code Primary: Alternate: Alternate: Company is a Corporation □ LLC □ Partnership □ Sole Proprietorship □ Principal Officers Name Title # of Years with Company
Affiliate-General-Contractor-Membership-Application-Rev-12-10-18.docx