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If Corporation or Partnership, please list names and addresses of Principals and their titles:*

Name, Address, License Number, Date

Additional Priniciple*

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How many years have you been in the industry?*

I have been actively engaged in the Plumbing Business as a Master Plumber or Heating, Cooling (HVAC), Supply or Mechanical Contracting Field for this many years.

Certificate of Competency No.*

Issued by the Examining Board of Plumbers in the City, Village or Town of:

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My Nassau Office of Consumers Affairs No. is

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Plumbing, Heating & Cooling Contractors of Long Island

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