Connecticut Onsite Wastewater Recycling Association

Connecticut Onsite Wastewater Recycling Association

P.O. Box 116, East Hampton, CT. 06424

Phone/Fax: 860-267-1057 Cell: 860-638-8188

E-mail: On the web at www.cowra-online.org

2017 Membership Invoice and Application

Annual Dues are $100 for the initial member and $75 for each additional member within thecompany. Make check payable to COWRA.

Please note: Member dues must be received by February 15, 2017 to guarantee that your company

is listed in the 2017 COWRA Member, Consumer and Suppliers Directories.

Name: ______Date: ______

Company Name: ______

Address: ______

(Note: The address listed here will be the address listed in the 2017 COWRA Member and Consumer Directory’s. All COWRA mailings will be sent to this address.)

City/State: ______ZIP______

Phone: (____) ______Fax: (____) ______

Email: ______Website:______

Please check: Employee Owner CT State License Number:______

Please check all appropriate boxes so that customers looking for your services will be able to find you in our website directories.

Installer / Pumper Cleaner / Engineer / Health Official

___ Septic System Installer ___ Excavation

___ Pumper / Cleaner ___ Foundations

___ Septic Inspections ___ Drainage

___ Civil Engineering & Design ___ Construction

___ Engineering Services ___ Demolition

___ Health Official ___ Trucking

___ Cameras / Videos ___ Waterproofing

___ Water Jet ___ Paving

___ Supplier ___ Surveying

___ Landscaping ___ Plumbing

___ Drain Cleaning ___ Proprietary Installation

___ Grease Trap Cleaning ___ Sewer Line Installation

Other services not listed ______

Normal Work Radius: ______

Suppliers

___Concrete Septic Products ___Plastic Septic Products

___ Pumps ___ Portable Toilets

___ Sand, Gravel & Topsoil ___ Chemical Products

___ Proprietary Systems Manufactures ___ Insurance

___ Drainage Products ___ Septic Tanks

___ Filter/Baffles ___ Drip Irrigation Products

___ Water Treatment Systems ___ Grease Stopper Products

Suppliers, please list other product categories. ______

PLEASE NOTE: COWRA USES THIS FORMS INFORMATION TO UPDATE OUR CONSUMER DIRECTORIES. FAILURE TO FILL OUT THIS FORM AND RETURN IT WITH YOUR MEMBERSHIP DUES MAY RESULT IN INCORRECT INFORMATION BEING PROVIDED TO CONSUMERS VIEWING OUR DIRECTORIES FOR OUR MEMBERS SERVICES. OUR DIRECTORIES ARE UPDATED EACH YEAR, ERRORS AND CHANGES ARE NOTED AND UPDATED WITH EACH MEMBERSHIP RENEWAL.