b'COMPANY NAME: ________________________________________________________ COMPANY ADDRESS: ____________________________________________________ CITY ______________________________ STATE______________ZIP_____________ PHONE ____________________________FAX ________________________________ URL: ___________________________________________________________________ In Business Since______________ DBX Member Reference: ____________________________ Primary Contact Person: _________________________________________________________ Email Address: _________________________________________________________________Additional Contact Names:Email Address _________________________ ________________________________________ Architect Conveying Systems Fire Protection MillworkAsphalt/Paving Doors/Hardware/ Painting/DcorFloo ring/Marble/TileAttorney/LawPartitions General Contractor RoofingBanking/FinancialDrilling Consultants Glass/Glazing/Windows Sheet MetalBonding/Insurance Drywall/Plaster/Ceiling Insulation Steel Erection/Fab.Carpentry Electrical Labor Union SupplierCommunications Elevators Landscaping Trade AssociationConcrete Engineer Masonry Underground UtilitiesConcrete/Masonry Equipment Rental Mech./HVAC/Plumbing Waterproofing SupplierExcavating Mechanical/HVAC Supplier WreckingConstruction Svcs Fencing Other _____________ Labor Affiliation:Union, Non-Union, Not ApplicableCertifications: SBE, DBE, FBE, MBE, EDGESend me info on BX OF DAYTON:Workers Comp Discount Program Health Insurance ProgramLegal Services PlanLegislative Activities Committee Participation Drug Free Workplace TrainingMember Vehicle Program TekCollect National Processing SolutionsBeeline Purchasing Brokers This application for membership into the Builders Exchange of Dayton is made subject to the Bylaws and Rules governing such membership. It isunderstood and agreed that, if and when approved by the Board of Directors, the applicant shall maintain his/her membership in good standing and shall terminate if only in writing and only after all obligations to the Builders Exchange of Dayton have been met. Please indicate level of service:Bronze: Annual Membership for Greater Dayton Area Company:$725.00 Silver: Membership plus Online News and Reporting Service:$975.00 Gold: Membership, News and Reporting Service, plus *Full Online Service Upgrade :$1635.00 Annual Membership for DBX Workers Comp Group Participants located outside of Greater Dayton Area:$100.00*(Full Online Service Upgrade includes access to all plans and specs online from any computer) Enclosed is a check made payable to Builders Exchange of DaytonOr pay by credit card below:VisaMasterCardAmerican ExpressDiscoverCard Number _________________________________Exp. Date _________________CSV________ Signature __________________________________________Billing Zip _________________ Please return application and payment to: BX of Dayton - 7250 Poe Ave Ste 410 - Dayton, Ohio 45414 - Fax: (937) 278-3843 9-15-2022'