JOIN THE DUCT CLEANERS' NETWORK!

Meeting the needs of individuals ... together. Certain fields are optional, but sharing this information has benefits.  All members have a listing on the DCN website for both consumer and trade purposes.  Consumers are able to search for duct cleaners in their area, and other duct cleaners are able to search member listings for project collaborations and such.  Also, DCN is promoting various programs for which certain company information and criteria will be used, such as M.I.X. Groups (Management Information Exchange), and training/mentoring programs.  Everyone's participation will be advantageous.

Required Information

Name_________________________________________________

Company Name__________________________________________

Address________________________________________________

City/ST/Zip_____________________________________________

Phone #______________________________

Email Address___________________________________________

Optional Information

Alternate Phone(s)_______________________________________

Fax #_________________________________

Web Address__________________________________________

Type of Business (duct cleaning, chimney sweeping, HVAC....)

________________________________________________________

Projects (check all that apply)

Residential___  Commercial___   Industrial___   Other___

Number of Years in Business_______

Number of Employees_______

Description of Duct Cleaning Equipment________________________________

_________________________________________________________________

Approximate Market Population______________________

Additional/Miscellaneous Information

_______________________________________________________________

_______________________________________________________________

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Please enclose check for $250 made payable to The Duct Cleaners' Network and send to:

Duct Cleaners' Network

11153 S. Wilton River Rd

New Richland, MN  56072

If you prefer to pay by credit card (circle one):

Visa     Mastercard     American Express

Card Number_________________________________________________

Expiration Date________________

Cardholder's Name____________________________________________

Zip Code of Billing Address__________________

I authorize the amount of $250 to be charged to my credit card.

Authorized Signature________________________________________