Use this Print Membership Form to join. We will promptly review each application.
Please print and fill out this form then fax it with a credit card number or copy of a check to 425-259-3832
or mail it with a check. Memberships are payable in advance. Thank you, we appreciate your business.

Online Plan Center
Membership - www.bxwa.com

BUILDERS EXCHANGE
OF WASHINGTON, INC.

2607 Wetmore Avenue
Everett WA 98201-2926

425-258-1303
425-259-3832 Fax

Membership is provided for use by employees of the named member company only, for one (1) regional office location only. Membership is non-refundable and non-transferable.

Member agrees to abide by all online Conditions Agreements.

Builders Exchange of Washington, Inc. reserves the right to refuse service to anyone.

Company Name
Address
City
State   Zip Code
 
Name
Position
 
Telephone
Fax
Email
Website
Company Contact
 
Referred by
Notes:
Please check the appropriate boxes to indicate membership term and payment method:
  12 months   
  $1,700.00   
  Fax Check for
  Electronic Transfer
  6 months   
  $1,100.00   
  Visa
    Master Card
    American Express
    Discover
    Check Enclosed
Printed: September 26, 2017, 2:14 am

Authorization Signature (Electronic Transfer or Credit Card)

X_______________________________________________

Name on Card
Card Number
Exp. Date

____________________________
____________________________
___ / ___    CVC (3-4 digits): ____
Billing Address1
Address2
City
State   Zip Code

Your Local Sales Tax Rate applies to WA sales:
      Rate: %    Amount: $    Total: $

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