I/we hereby apply for membership in Service Station Dealers of Greater New York, Inc. whose purpose is: to foster fair standards of business practice in all branches of the automotive retail service industry; to foster legislation — local, state and national of benefit to its members; to disseminate such information as is of benefit and vital to its members and the motoring public.

Business Name:

Business Address:

Town:     County    Zip:

Phone:   Email:

Proprietorship:                          Partnership:                       Corporation:
 

Name (Owner or Operator) 

Home Address:           

Brand of Gas Sold:      Repair Shop Only: 

Add Medical Insurance to Billing:

Add DBL to Billing:                                  Gas w/Convenience Store:

Repair Shop Number:

Dues fee is payable four months in advance upon signing then monthly

Date:

I understand and agree that this application is for membership in the Service Station Dealers of Greater NY, Inc. at the prevailing monthly membership rate. I am responsible for the dues each month unless I notify the Service Station Dealers of Greater NV, Inc. in writing 30 days in advance that I no longer desire membership. All outstanding dues, fees, premiums and moneys due must be paid upon cancellation.

As the owner of or a principal in the member business herein, I guarantee that any and all moneys due Service Station Dealers of Greater NY, Inc. will be paid and paid in a timely manner.

I agree: