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IMDA Membership
Directory Order Form
Membership Directory Available
- Firm Name
- Person to Contact
- Address
- Phone and Fax Number
- Area(s) of Specialization
- Territory Covered
Our membership directory is available to manufacturers who are seeking
specialty distributors. The directory lists over 75 firms, covering the
entire United States.
| Name: |
________________________________________ |
| Company: |
________________________________________ |
| Address: |
________________________________________ |
| City: |
__________________ State: _____ Zip:
____________ |
| Phone: |
__________________ |
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| E-mail Directory to: |
____________________________________________________ |
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| Payment Information: |
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| ___ Enclosed is my $175 check (payable to
IMDA). |
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| ___ Enclosed is Visa, MasterCard or
American Express card information. |
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Card No.: _____________________________________
Expiration Date: _________________________________
Name on Card: _________________________________
Credit card billing address:
_____________________________________________
Signature: _____________________________________ |
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To order, please print this page, complete this form, and return with
payment for $175.00.
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