Retailer Business Info  

COMPANY NAME 

BUSINESS MAILING ADDRESS
CITY

STATE/ PROVINCE

COUNTRY
ZIP/POSTAL CODE  

TELEPHONE:

AREA CODE AND-OR COUNTRY CODE

FAX

AREA CODE AND-OR COUNTRY CODE

WEB SITE

MEMBER REPRESENTATIVE  

Mr./Ms./ Dr/

FULL NAME

JOB TITLE

CELL:

AREA CODE AND-OR COUNTRY CODE

We were referred to AETA by:

DUES CATEGORY   Select Your Size Category Small Retailer (under $500K) Dues= $125 Retailer Medium ($500K to $1 million) Dues = $175 Large Retailer (over $1 million) Dues= $225

We will pay by check instead of credit card.