Print Subscription Form

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.

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
BXWA Salesman

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_______________________
_______________________
_______________

_______________________
_______________________

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_______________________
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_______________________

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Notes:
______________________________________
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Please check the appropriate boxes to indicate membership term and payment method:

12 months
$1,700.00

6 months
$1,100.00

Fax Check for
Electronic Transfer

Visa

Master Card

American Express

Discover

Check Enclosed

Authorization Signature Electronic Transfer or Credit Card X____________________________________________
Name on Card Card Number Exp. Date Billing Address Zip Code	_________________________ _________________________ _____ / _____ _________________________ ________

Printed: July 8, 2008, 9:19 pm