Application

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SUPPORT THE ASSOCIATION THAT SUPPORTS YOU

TIRE DEALERS ASSOCIATION OF WESTERN PENNSYLVANIA

2016 MEMBERSHIP APPLICATION

ANNUAL DUES $125.00

NAME OF BUSINESS:_______________________________________

ADDRESS:________________________________________________

CITY/STATE/ZIP CODE:____________________________________

PHONE:_____________________FAX:_________________________

CONTACT PERSON:_________________________________________

TYPE OF BUSINESS:_______________________________________

TYPES OF SERVICE:_______________________________________

PLEASE MAKE CHECK PAYABLE & RETURN TO:

TIRE DEALERS ASSOCIATION OF WESTERN PENNSYLVANIA
POST OFFICE BOX 1524
GREENSBURG, PA. 15601

Federated Insurance