New England Car Wash



MEMBERSHIP APPLICATION Term: through Dec. 31st

Please fill out completely. Mail OR fax this form to 781/245-6487 with

credit card information or mail with a check for $275 payable to NECA.

CAR WASH OR COMPANY NAME REFERRED BY

FULL NAME OF MEMBER OF RECORD NICKNAME

JOB TITLE PARENT COMPANY

PRINCIPAL/OWNER (IF DIFFERENT THAN MEMBER OF RECORD)

PHONE ( ) FAX ( ) CELL ( )

E-MAIL WEB SITE

ADDRESS CITY STATE ZIP -

SHIPPING ADDRESS (IF DIFFERENT)

CITY: ________________________________________ STATE: ___________ ZIP -

MEMBERSHIP TYPE: Please check the category that describes the business listed above.

CAR CARE/OPERATOR: FULL SERVICE EXTERIOR IN-BAY AUTOmatic SELF- SERVE BAYS DETAILING

CHECK ADDITIONAL SERVICES THAT YOU PROVIDE: GASOLINE Q-LUBE C-STORE EQUIPMENT SALES/SERVICE PROPANE

DOG WASH OTHER:

TOTAL # OF LOCATIONS? IN WHICH TOWNS ARE YOUR FACILITIES LOCATED?

industry partner/SUPPLIER OTHER TYPE OF MEMBER BRIEFLY DESCRIBE YOUR PRODUCT OR SERVICE FOR WEB SITE POSTING.

We encourage you to get more involved in NECA activities and initiatives. Please check your interests:

TABLE TOP SHOW GOLF OUTING NORTHEAST CARWASHER MEMBERSHIP EDUCATION SCHOLARSHIP

DINNER MEETINGS MEMBER SERVICES LEGISLATIVE/REGULATORY NECA E-NEWS MENTORING NRCC

BEST PRACTICES GREEN INITIATIVES WEB SITE, FACEBOOK wash for a cause OTHER

yOUR MEMBERSHIP COVERS YOUR ENTIRE COMPANY AND ITS EMPLOYEES. please fill out the following for complimentary COMMUNICATIONS (MAIL AND E-MAIL) for additional key staff members from your company.

NAME TITLE

LOCATION NAME ADDRESS

CITY STATE ZIP -

PHONE ( ) FAX ( ) CELL ( )

E-MAIL

NAME TITLE

LOCATION NAME ADDRESS

CITY STATE ZIP -

PHONE ( ) FAX ( ) CELL ( )

E-MAIL

CHECK ONE

MC VISA AMEX DISCOVER # EXPIRATION /

NAME AS PRINTED ON CARD TOTAL CHARGE $ security code ____________

BILLING ADDRESS CITY STATE ZIP

(IF DIFFERENT THAN ABOVE)

Membership dues are not deductible as charitable contributions. Dues may be deductible as ordinary and necessary business expenses.

NECA ( 591 North Avenue, Ste. 3-2 ( Wakefield, MA 01880-1617

781/245-7400 ( F781/245-6487 ( info@ (

UPDATED 4/4/2013

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