Vendor Membership Application for Manufacturers' Representatives

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For a company that joins as a new member after January 31 of the current fiscal year, any prorated portion of the paid annual dues will appear as a credit on the renewal notice for the following fiscal year. Dues, contributions or gifts to ASA are not deductible as charitable contributions for federal income tax purposes. However, dues payments are deductible by members as an ordinary and necessary business expense.

Company Information

Company Name

Main Phone

Main Fax

Website

Applicant is a (select one):

Total number of employees?

Applicant has operated under the present ownership (indicate since year or # of years):

Territory covered (i.e. list each state/province)

Lines represented

Headquarters Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Please select a dues amount:

The fiscal year is January 1 thru December 31. Annual dues are based on a company's total annual sales volume for plumbing-heating-cooling-piping (PHCP) and industrial pipe-valve-fitting (PVF) products only. Please indicate total sales volume (PHCP-PVF products only). This annual dues schedule is valid until December 31 of the current calendar year.