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Vendor Membership
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Membership
Vendor Membership
Vendor Membership
Membership Type
*
Vendor Membership - $250
Company Name
*
Street Address
*
Street Address Line 2
City
*
State / Province
*
Postal / ZIP Code
*
Country
*
Please Select
United States
Canada
Mexico
Website Address
*
Number of Employees in COESRA
*
Please enter a number from
0
to
500000
.
Representative Details
First Name
*
Last Name
*
E-mail
*
Phone Number
*
Ext
Fax
Alternate Representative
*
Job Title
*
E-mail
*
Phone Number
*
Ext
Fax
Number of Cards Requested
*
Please enter a number from
0
to
500000
.
Submitting Your Discount Information
PLEASE READ! FAILURE TO FOLLOWING INSTRUCTIONS BELOW WILL DELAY YOUR MEMBERSHIP You must submit a copy of your flier (preferably in PDF format), coupon or website for approval, at the time of application. The flier must prominently state or show the phrase "COESRA DISCOUNT", state the percentage or type of discount, and be no larger than 4 mb in size. Make your flier attractive, descriptive and interesting to the reader. Please give a full description of your product and/or service. Be specific about any limitations on the discount. Colors & graphics should be appropriate for making copies within companies and/or printing from the internet. After your approval by the COESRA Board, you will be asked to email a final copy of your approved flier to vendors@coesra.org. The file will only be posted on the website if 4 mb or less in size. As part of your membership fee, the flier will be posted on the COESRA website, as soon as possible.
File
*
Discount Information
*
Please explain the discounts you will be offering.
Company Information
*
Please briefly describe your company.
Payment Method
You will have the option to pay online or mail your payment upon submission of this form. For your records, a copy of this form will be sent to the email address indicated agove. Please direct any questions to
vendors@coesra.org
.
One Year Payment or Recurring?
*
One Year - $250
Recurring - $250/year
Payment Method
*
Credit Card Online
Check by Mail
Credit Card or PayPal Vendor Membership
Your Membership Key
