HEMSA Membership Application form Issue 4 151209 by Ob6Nhe9

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									                                                     Highdown House, Littlehampton Road, Ferring, BN12 6PG

                                                     Tel: 01903 705140
                                                     Fax: 01903 705149

      Highway Electrical Manufacturers and           Email: info@highwayelectrical.org.uk
      Suppliers Association                          www.highwayelectrical.org.uk/hemsa


               APPLICATION FOR MEMBERSHIP
     No                     Item                                             Response
      1       Organisation Name

              Address
      2


              Tel
      3
              Fax

              Email
      4
              Website

      5       Name of Applicant

      6       Position

      7       Company Registration (if
              applicable)

      8       Number of Years Trading

              Turnover in last Financial
      9
              Year

              Percentage of business in
     10
              Highway Electrical sector

              Description of activity in
     11
              Highway Electrical Industry

     12       Number of Employees

     13       QA Registration No

     14       Customer References                   Please attach two customer references
 I certify that the information supplied is accurate to the best of my knowledge and accept that HEMSA may require
 additional information in support of this application, such as company accounts, health and safety information etc. I
 also accept that a visit to our premises by an auditor of HEMSA will be necessary before my application is
 considered and the charge for this will be £390 + VAT, which will be paid by my organisation. I understand that if
 our organisation is accepted as a member by HEMSA Council, the membership fee of £1500 pa will be payable
 upon request and that the invoice for membership would normally be rendered prior to the membership year for
 which it is applicable. Finally I acknowledge that I am aware of the HEMSA Code of Conduct and will abide by that
 if accepted as a member.

SIGNATURE……………………………………………                                          DATE………………………….
  HEMSA Application form                     Page 1 of 1                             Issue 4 151209

								
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