Business Name:
Representative to Contact:
Title:
Business Address:
City:
State:	Zip:
Phone:
Fax:
Email:
Web:
Check enclosed:	or bill my Visa Mastercard
Card Number
Expiration Date (mm/dd/yy)
Billing Address
City, State, Zip
Type of Membership and Annual Dues:	$450.00 - Builder or Remodelor Member $450.00 - Associate Member (less than ten employees) $550.00 - Associate Member (ten or more employees)
Length of time in business:
Number of Employees:
Type of Business:
If builder, Number of Dwellings Per Year:
CT Registration:	NHCC:    HIC:
Other License (please specify):
Annual Dollar Value of New Construction Per Year:
Please list references below. (2 references required) Include business name, contact name, address and phone number. (Associates - list builders for whom you have worked) (Builders - list subcontractors and clients)
Business Name:
Contact:
Address:
Phone:
Business Name:
Contact:
Address:
Phone:
Please list bank/credit references below. (2 references required) Include name, contact, address and phone.
Business Name:
Contact:
Address:
Phone:
Business Name:
Contact:
Address:
Phone:
Your application is not complete until our office receives your signed oath and payment. Click here to download the oath. Please sign it and mail it with your payment to: BAEC, 20 Hartford Rd, Suite 18, Salem, CT 06420 The oath can be viewed by using Adobe® Acrobat® Reader™. If you do not have Adobe® Acrobat® Reader™ installed on your computer, you can download it free by clicking here.