Join or Renew as an Associate

For manufacturers that want to partner with us to provide beneficial services to our retail members. Please complete the form below to renew your annual membership and/or setup an auto-renew payment for current membership dues.

Join or Renew as an Associate *

Annual Associate Membership - $ 995.00

Please renew my membership automatically.

Total Amount

Primary Contact's Email Address *

Associate Organization

Company Name *

Street Address *

City *

State *

Postal/Zip Code *

Country

Business Phone *

Business Email *

Website *

What services does your company provide? *

Services for Retail Members (brick-and-mortar stores)

Services for Brand Members (other companies that provide retail goods)

Services for both Retail and Brand Members

Secondary website URL for Retailer Portal or Landing Page (type N/A if not applicable) *

Do you have a company logo to provide for our member directory? *

Yes No

Company Logo

Total prior year revenue *

Please enter a Username to create an account. If you already have an account please login before completing this form.

Username *

Check Availability
Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

Primary Contact Information

First Name *

Last Name *

Job Title *

Work Phone *

Cell Phone

Street Address *

City *

Country *

To select a state, first select a country above.

State *

Zip/Postal Code *

Credit Card Information

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

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