New Jersey PHCC Membership Application Payment options o Annually (only option for Intro. Rate) o Active Member Regular: $795 o Bi-Annually (National & State Dues included; local dues extra) o Introductory Membership:$552.00 o Quarterly (Dues must be paid in full for the year to qualify for Introductory rate.includes National & State, additional fee for local if applicable) o Monthly Please note: All installment dues payments, i.e. semi-annually, quarterly or monthly, will incur a 2.4% service charge. ____________________________________________________________________ Contact Name Title __________________________________________________________________________ Company Name Company Website PHCC membership dues are not deductible as a charitable contributionfor U.S. Federal income tax purposes, but may be deductible as a business expense __________________________________________________________________________ Company Address City State Zip Mission Statement: PHCC is dedicated to the promotion, advancement, education and training of the industry for the protection of our environment and the health, safety and comfort of society. __________________________________________________________________________ Home Address City State Zip __________________________________________________________________________ Home Phone Email Business Phone Business Fax __________________________________________________________________________ Spouse Name License # DOB Method of payment: o o o Check Enclosed Credit card Request invoice for online payment (please provide email address to send invoice) Type of CC Card: ⃝ Visa ⃝ MC ⃝ Amex ⃝ Discover CC #____________________________________ EXP_______ CVV________ Name on Card_________________________ Credit Card Billing Address:: ___________________________________________________ Keep You and Your Business Healthy with one of your NJPHCC Member Benefits: • • • • • Access to medical and dental plans that provide coverage through Horizon Blue Cross Blue Shield of New jersey and Delta Dental Plan of New Jersey Core medical products include PPO plans and a remarkable POS plan. No primary care physician (gatekeeper) requirement or referral hassle Extremely competitive pricing that may offer some of the lowest rates in NJ. The NJPHCC is the only state trade association servicing all sectors of the plumbing, heating and cooling industry. Formed in 1902 the NJPHCC is affiliated with the Plumbing-Heating-Cooling-Contractors National Association, and has local affiliates throughout the state.