Manufacturer/Associate Membership Application

Our firm applies for admission to Associate in STAFDA. At least 50% of our sales are through independent distributors and STAFDA members will play an important role in that marketing program.

I acknowledge that STAFDA annual dues are $350.

STAFDA may charge my Credit Card for the $350 dues.

Company Name

Mailing Address

Street Address

City

State

Postal Code

Country

Phone

Toll Free

Fax

Website

Your Company Contact

Title

Description of Product Line

Year Your Business Was Founded

Total Number of Employees

Number of Direct Sales People

Number of Manufacturer's Agents

Percent of Our Total Sales Volume Done By Construction / Industrial Distributors (est.)

Number of Factory Owned Distributor / Warehouse Service Facilities We Operate

Our STAFDA Contact Is Also Responsible For Canadian Sales

Annual Sales

Our Major Competitors Are

We Participate in These National Trade Associations and/or Conventions/Shows

How did you hear of STAFDA?

Rank Top 5 Choices for Convention Sites

Payment Information

Credit Card Number

Expiration Date /

CVV

First Name

Last Name

Billing Address

City

State

Postal Code

Country