OPEAA - Membership Application

OPEAA Membership Application

1 - Company Information

Company Name:

Mailing Address:

City, State, Zip:

Street Address (if different from above):

City, State, Zip:

Contact Member Name & Title: (this will be your "Voting Representative")

Direct Email:

Direct Phone:

Direct Fax:

General Phone:

General Fax:

Website:

This form was completed by: (name & date)

2 - Additional Contact Names

Please list any individuals below, that you wish to be included in the Membership Directory. Please include address information only if it is different than SECTION 1 above. Also include the individual's email address, and direct phone number if applicable.

Contact #2:

Check here if individual should receive correspondence:

Yes

Contact #3:

Check here if individual should receive correspondence:

Yes

Contact #4:

Check here if individual should receive correspondence:

Yes

3 - Annual Dues

Annual Dues (Based on Aftermarket Sales)
Please Select one: (confidential)

How would you like to pay your Annual Dues?
Please Select one:

4 - Business Information

Marketing Region(s):

Year Founded:

Number of Employees:

Please tell us about your company:

Number of locations/branches:

Please select one:

Manufacturer Distributor Independent Manufacturers' Representatives (IMR) Other

If Other, please explain:

Other associations of which your company is a member:

The three major products categories your company sells, in order of importance:

#1:

#2:

#3:

Major brands your company distributes:

Briefly indicate what benefits you expect from your OPEAA membership:

Please use the box below for any General Comments you may wish to make:

Have you read, and do you agree to adopt the limited warranty and product liability policies of OPEAA?

Yes No

Do you promise to abide by the Code of Ethics as prescribed by OPEAA?

Yes No

Do you attest that all information provided here is true and accurate, to the best of your knowledge?

Yes No

The Outdoor Power Equipment Aftermarket Association

For more information:
OPEAA
1726 M Street, NW - Suite 1101
Washington, DC 20036 US
Email: opeaa@opeaa.org
202-775-8605
Fax: 202-833-1577