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2016 Membership Application

NY Fire Alarm Assoc.
(A Non-Profit Organization)
1 Teleport Drive, suite 202
Staten Island, NY, 10311
Tel#516-328-6932 Fax#516-706-0633
info@nyfaa.org

Instructions: Answer all questions that apply so we can keep you up to date in our computer Then fill out only ONE section at the end of this form that pertains to your type of membership! This is a four page application.

Type of membership:

Company Information

Applicants Company Name:
Applicants Company Name (dba):
Mailing Address:
City:
State:
Zip +4 Code:
Email Address to Receive Notices:
Office Telephone Number:

Owner/Officer(s)

Name:
Title:
Cell Phone:
Name:
Title:
Cell Phone:

Representatives

List individuals and their titles to represent your firm. Do they have the authority to speak and make decisions on behalf of your firm?

Name:
Title:
Name:
Title:
Brief description of your firm:
List the areas your firm covers geographically
Number of Employees:

Type of Membership: Fire Alarm System Distributors and Service Organization Member

New York State License #:
Other Licenses:
Other Licenses:
List NICET Certificated officer or owner, and areas certified in.
Is the firm approved as a New York City Smoke Detector Maintenance Company?
YesNo
Certificate #:
Is the firm approved as a NYC Fire Alarm Service, Test and Inspection Company (S97):
YesNo
S97 Certificate #:
Cardholder Name:
List manufacturers and product lists that you are factory authorized to sell and service.
What percentage of your business is fire alarm related (sale and services)?

Type of Membership: Central Station Fire Alarm Monitoring Company Member

U.L Listed Listing #:
F.M. Approved Approval #:
New York City Fire Department Approved

Type of Membership: Engineering Firm Member

1a. Professional Business Entity Name:
1b. Professional Business Entity (select one):
1c. Registration current through (date):
2a. Certificate of Authorization to provide
Professional Engineering Services in New
York State (select one):
2b. Certificate Number:
2c. Expiration Date:
3a. Principal's Name:
3b. License Number:
3c. Registered through (date):

Type of Membership: Manufacturer Member

Products Manufactured:
ISO Certified?

Affirmation of Accuracy of Information I attest that all the information in this application is true to my best knowledge and permit the confirmation and verification of the information stated. I further acknowledge that any misinformation or errors may require further information. Failure to provide this information may prevent this form from being processed and approved. Misrepresentations may also prevent further processing of future applications from your firm or associated organizations

DO NOT SEND PAYMENT WITH THIS APPLICATION WHEN IT IS SUBMITTED

All information on each submitted application is verified at the NYFAA office. Once verified, the NYFAA Board of Directors confirm that the requirements have been met for the membership classification requested, and subsequently vote on each request for membership based on verified information. Once approved, the NYFAA office will contact the company applying for membership to advise of the Board’s determination. An invoice will then be generated to the accepted company based on the approved classification. Payment may then be made to the NYFAA Via credit card or check.