Company Information:

Legal Name
DBA
Street Address City State Zip
Mailing Address City State Zip
Phone Fax Email
Web Site Address
Owner Primary Contact
Buying Group Affiliations
Number of Full-time Employees (Include owners and all employees working 30 or more hours per week at all locations combined.)
Number of Branch Stores (Please list information on branches in the space provided below.)

Membership and Dues Category:

It is understood that, if accepted into membership, I/We will abide by the Articles of Incorporation and the Bylaws of the Association as now constituted or hereafter amended and will pay annual dues. (Check one)

Please check payment method: Check    Visa    Mastercard     American Express

Membership is not active until payment is received. If paying by credit card, CAWA will call you for the information. Membership dues are non-refundable.

Membership Definitions:

Active Member (Firms, corporations, or individuals whose main business is the distribution of automotive parts, supplies, tools, equipment and accessories and are located in the state(s) of California or Nevada.)
Jobber | WD | PBE | TBA | Retailer | Other

Associate Member (Firms, corporations, or individuals located in or out of the states of California or Nevada which do not qualify for active membership, but are otherwise related to the automotive industry.)
Machine Shop | Auto Glass | Repair Facility | Out of State | Other

Manufacturer Member (Firms, corporations, or individuals whose main business is related to manufacturing automotive parts, supplies, tools, equipment or accessories for distribution.)
Manufacturer | Manufacturer's Representative | Re-Manufacturer

Affiliate Member (Firms, corporations, or individuals who provide service and/or products to the Association or its members, but are not related to the automotive industry. May be located in or out of the state of California or Nevada.)
Insurance | Computer Related | Business Services | Consulting
Other

Branch Locations: (please attach additional sheets if necessary)

1. Store Name Contact Name/Title
Street Address City State Zip
Mailing Address City State Zip
Phone Fax Email

2. Store Name Contact Name/Title
Street Address City State Zip
Mailing Address City State Zip
Phone Fax Email

3. Store Name Contact Name/Title
Street Address City State Zip
Mailing Address City State Zip
Phone Fax Email

There are more locations, and I will fax them to CAWA Membership at
916-635-9995.

It is further understood I/We will give thirty (30) days written notice to the Association in the event of resignation. I/We understand dues are billed annually by anniversary date. Enclosed is my check covering my first year dues, plus the one-time inaugural fee of $50.00. Contributions or gifts to the California/Nevada/Arizona Automotive Wholesalers’ Association are not tax deductible as charitable contributions for Federal income tax purposes. However, they may be tax deductible under other provisions of the Internal Revenue Code except that portion of your dues that is allocated to Association political and lobbying expense.

CAWA will keep you up to date on critical issues affecting the aftermarket industry and your membership. These updates will be sent via e-mail, fax, or mail.

**I understand that by providing my fax number, and/or e-mail address and signing this application, I consent to receiving faxes/emails sent by CAWA and its subsidiaries and affiliates. I also understand that membership dues are non-refundable.

Signed, Title

Date