(For trailer manufacturers building trailers under 26,000 lbs. GVWR)

   
Organization Information (to be displayed online)
Organization Name *
Physical Address 1 *
Physical Address 2
City *
State *
Zip *
Country
Phone *
Fax
Website
Billing Address (if different)
Street
City
State
Zip
Country
Mailing Address (if different)
Street
City
State
Zip
Country
Main Contact
First Name *
Last Name *
Address 1 *
Address 2
City *
State *
Zip *
Country
Title
Phone *
Email *
Additional Contacts
President/CEO
Name
Phone
Email
Purchasing Agent
Name
Phone
Email
Compliance Program Designee
Name
Phone
Email
Sales
Name
Phone
Email
Engineering
Name
Phone
Email
Marketing
Name
Phone
Email
Accounting
Name
Phone
Email
Additional Information
This information in this section is confidential and will be used solely as part of an aggregate number for legislative efforts.
Year Established
WMI (Required)
Are you currently manufacturing trailers?
If not, when do you intend to begin manufacturing trailers?
Number trailers manufactured last model year
Referred by
Number of Employees:
This company manufactures trailers weighing: 0-10,000 lbs GVWR
10-26,000 lbs GVWR
Over 26000 lbs GVWR
I agree to adhere and abide by the Bylaws of the Association (available by email or at www.NATM.com), and understand that participation in the NATM Compliance Verification Program is a requirement of Regular membership. *

Other Paperwork Requested
The NATM Membership Committee requires that all Regular (trailer manufacturing) member applicants submit their World Manufacturer Identification (WMI) number with their application. If you have questions or need more information, contact Bill Toffelmire, Membership and Education Director, (785) 272-4433 or by e-mail Bill.Toffelmire@natm.com.
Membership Investment
Membership Type: *
**Hold CTRL on your keyboard to select multiple categories**

NATM membership is based on a calendar year, January 1 to December 31. Payment of full membership dues must be made with this application. If you join after January, a portion of your membership dues will be applied to the following year’s dues. Membership renewal statements are sent out each November for the next calendar year.


   
Total: $ 

The contents of this box are for testing purposes. This box will be removed when the form goes live.
Full-Time Employees
Part-Time Employees
Hotel/Motel Rooms
Restaurant Seats
Additional Associates
Additional Associates Cost
Additional Locations
Additional Locations Cost
Assets
Assets Cost
AdditionalCategories
Additional Categories Cost
NumberOfAdditionalCategories
additionalItem1Cost
Annual Dues (charged to card)
Tax (charged to card)
Fee (charged to card)
tempValueForDropDown1
Primary Directory Category *
Number of Employees:  
Number of Part Time Employees:  
Number of Rooms (Accommodations):  
Number of Seats (Restaurants):  
Number of Associates (Realtors, Attorneys):  
Number of Locations ($35/add. location):  
Millions in Assets (Financial Institutions):  
Enhanced Membership ($50):
$ 
$ 
$ 
*
NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.
Credit Card Information
Credit Card Type *
Credit Card Number *
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Credit Card Phone Number
Credit Card Country
Credit Card Email Address
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