Submit your application online or print it out and return it to:
The Electrocoat Association, PO Box 541083, Cincinnati, Ohio 45254
800-579-8806 or 800-563-8831, Fax: 513-527-8801.

Note: Please be sure all information is EXACTLY how you wish it to appear in our database.

Company Name:
Delegated Representative: Title:
Alternate Representative: Title:
Mailing Address:
P.O. Box:
City:
State:
Zip:
Country:
Phone:
Fax Number:
Website:
E-mail Address:
Business Description:


Organizational Classification
From the list below, please select the code which best classifies your organization.

25-Furniture & Fixtures
28-Chemicals & Allied Products
33-Primary Metal Industries
34-Fabricated Metal Products
35-Industrial & Commercial Machinery & Computer Equipment 		36-Electric, Electronic & Household Equip.
37-Transportation Equipment
38-Instruments, Controls & Related Products
39-Misc. Manufacturing Industries
50-Other, Please Specify

Membership Agreement:
I hereby apply for membership in THE ELECTROCOAT ASSOCIATION. I agree to abide by the Bylaws and Operating Guidelines in the Association. I agree that in order to affirm my Membership in the Association, I must pay all applicable membership dues. Dues are non-refundable.

Name:
Title: Date:


Membership Status
I/We are applying for Membership in the following category/categories:
Annual Dues unless otherwise specified.

Corporate Membership

Tier 1 - OEM Equipment Supplier
$0-5 million $2,700
$5-10 mm $3,800
$10-20 mm $4,900
$20 mm-up $6,000

Tier 2 - Component Supplier
$0-1 million $1,300
$1-5 mm $1,900
$5 mm-up $2,500

Tier 3 - Job Shop or Custom Coater
$0-2 million $500
$2-5 mm $1,000
$5-7 mm $1,300
$7-10 mm $1,900
$10 mm-up $2,500

Individual Membership

Tier 1- Captive Shop $25
Tier 2- Individuals not otherwise qualified as Corporate Members $75

Educational Membership

$100 Schools, colleges, universities, apprenticeship programs.
$30 Students (One-time processing fee while registered in an educational program.)

Payment Options:

Visa, MC, Amex
     exp. date      Sec. Code

Check

P.O. #

How did you hear about The Electrocoat Association? Please list the company and/or individual who encouraged you to join the Association



Note: Contributions, gifts, or membership dues paid to THE ELECTROCOAT ASSOCIATION are not deductible as charitable contributions for Federal income tax purposes. This law does not affect the deductibility of these payments as business expenses.