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Yes, I wish to become an associate member of the Qualified Gas Contractors Association. If accepted I will live up to and support the CODE OF ETHICS and BYLAWS of the association.

Pick only one chapter per application

Peninsula

South Hampton Roads

Suffolk

My firm is licensed in the city of

State

Firm Name

Address

Address City State ZIP

Phone

Fax

Website

Contact Person

Address and phone if different from above

Referred by

My firm has been registered in the state of Virginia for a minimum of 2 years.

Yes

Please Have The Following Ready To Submit When We Contact You.

Insurance Certificate for the past 24 months
Business License for the past 24 Months
State Contractor’s License HVA-GFC or PLB-GFC for the past 24 months
Tradesmen certificate of the designated employee past 24 months
Letters of recommendations from 2 current QGC members or Distributors )

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By submitting this information, you acknowledge that all the information in this application is true to the best of your ability.

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Application For Associate Membership (Peninsula)