Online Membership Application

Company Name *

Address 1 *

Address 2

City *

Province *

Postal Code*

Phone *

Fax

Web Site

Representative Name *

Representative Email*

Encouraged to Join by LHBA Member Company*

LHBA Member Company's Representative

Description of Business

--- Select --- Builder Renovator Builder/Renovator Financial Professional Services Supplier Sub-Trade

Year The Business Began*

Have You Previously Owned a Business*

--- Select --- Yes No

Have You Claimed Bankruptcy In The Last 5 Years*

--- Select --- Yes No

Tarion

Customer References

1. Company*

1. Contact*

1. Phone*

1. Fax

1. Email

2. Company *

2. Contact*

2. Phone *

2. Fax

2. Email

Sub-Contractor References

1. Company *

1. Contact*

1. Phone*

1. Fax

1. Email

2. Company*

2. Contact *

2. Phone *

2. Fax

2. Email

Suppliers References

1. Company *

1. Contact*

1. Phone*

1. Fax

1. Email

2. Company*

2. Contact*

2. Phone*

2. Fax

2. Email

Bank Reference

Name*

Contact*

Phone*

Fax

Email