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
BXWA Salesman
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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

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_____ / _____

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Your Local Sales Tax Rate applies to WA sales:
Rate: ______%  Amount: $________  Total: $________
Printed: September 6, 2010, 5:02 am