Application for Associate Membership

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Company Name *

Contact Person *

Date Business Started

Business Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

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Federal ID Number

Phone *

Fax

Email *

Website

Type of business

• Sole Proprietorship
• Partnership
• Corporation

Number of employees

Products and/or services offered to wholesalers

Other trade associations you are affiliated with

Service (select all that apply)

• BP – Business Press
• CP – Computer Services
• SC – Core Supplier
• ED – Engine/Engine Component Distributor
• M – Importer
• MP – Manual Publisher
• RM – Remanufacturer
• SS – Shop Supplies
• VT – Vocational Training
• WD – Warehouse Distributor
• Other

Manufacturer (select all that apply)

• CM – Chemical Adhesive Manufacturer
• EM – Equipment Manufacturer/Supplier
• MR – Manufacturer Rep or Agent
• PM – Parts Mfr or Supplier/Distributor

How did you hear about AERA? *

• Another member
• Engine Professional magazine
• Conference
• Social media
• Prosis Pro demo
• Other

Membership dues *

• Manufacturer Rep, Agent or Business Press: $460
• $0-$1 million in automotive sales: $690
• $1-$3 million in automotive sales: $790
• Over $3 million in automotive sales: $890

Total

$0.00

Payment *

Card Number

MM123456789101112Expiration

/

YY2627282930313233343536

Security Code

Submit

Monthly Payment Option

If you would like a monthly payment plan, we need your confirmation in writing.
Please print out the PDF below and return completed form to AERA.

Monthly Payment Agreement (PDF)

QUESTIONS? Call 888-326-2372 or email karen@aera.org