NACM CANADIAN COMPUTER PRODUCTS DISTRIBUTORS TRADE GROUP

APPLICATION FOR MEMBERSHIP

In order for us to ascertain your company qualifications for the Canadian Computer Products Distributors Trade Group, please complete the following application and return it to:

NACM Tampa Inc.
PO Box 22827
Tampa, FL 33622

APPLICANT COMPANY NAME:
TELEPHONE: EXT:

MAILING ADDRESS:

FAX NUMBER:

800 NUMBER :

E-mail Address:

CITY / ST / ZIP:

NAME(S) OF INDIVIDUAL(S) RESPONSIBLE FOR CREDIT FUNCTIONS AND WHO WILL ATTEND MEETINGS: (CREDIT MANAGER)

NAME: TITLE:
E-mail address:
NAME: TITLE:
E-mail address:

PARENT COMPANY:

ANNUAL SALES VOLUME:

YEARS ESTABLISHED:

NUMBER OF ACTIVE CUSTOMERS:

MARKET AREA:

NUMBER OF EMPLOYEES:

What PERCENTAGE of REVENUE comes from End-Users:

GENERAL PRODUCTS DISTRIBUTED/VENDORS YOU DISTRIBUTE FOR:

SUBMITTED BY:

AUTHORIZED SIGNATURE & TITLE:

DATE:

Company agrees to an appropriate credit investigation, prior to the NACM Tampa Inc. Board of Advisors approval. Companies must be approved by the Association Board of Directors and appropriate Trade Group Board of Advisors.