PETROLEUM EQUIPMENT,
SUPPLYING OR SERVICING COMPANY
MEMBERSHIP
911B South Eisenhower Blvd.
Middletown, PA 17057
Phone: (717) 939-1781
Fax: (717) 939-2015
[email protected]
www.papetroleum.org
A S S O C I A T E A P P L I C A T I O N
We are a petroleum equipment, supplying or servicing company applying for Associate membership in the above
Association and agree to pay the annual dues of $381.00 for the category(s) indicated on the reverse side.
PLEASE TYPE OR PRINT AND COMPLETE SERVICE CATEGORIES ON REVERSE SIDE.
Company __________________________________________________________________________________________
Street Address ______________________________________________________________________________________
City ______________________________________________________________State_________ Zip ________________
Mailing Address _____________________________________________________________________________________
City ______________________________________________________________State_________ Zip ________________
County_____________________________ Phone (_____) ____________________ Fax (_____) ___________________
Web Site URL_________________________________ E-Mail Address ________________________________________
I understand that the information above will be published in the PPA Membership Directory and will,
therefore, be available for use by any person who is able to obtain a copy of the Directory.
I understand that electronic communications may contain material that could be deemed unsolicited
advertising under FCC rules. I hereby grant to PPA express permission to deliver such communications to the
applicable facsimile number and/or e-mail address designated above.
_______________________________________________
Company Representative Name & Title
(Name to be shown in Directory)
________________________________________________
Authorizing Signature
PAYMENT MUST ACCOMPANY APPLICATION: _____$381.00 Check Enclosed
CONTRIBUTIONS OR GIFTS TO PPA ARE NOT DEDUCTIBLE AS CHARITABLE CONTRIBUTIONS FOR FEDERAL INCOME TAX PURPOSES. HOWEVER, DUES
PAYMENTS MAY BE DEDUCTIBLE BY MEMBERS AS AN ORDINARY AND NECESSARY BUSINESS EXPENSE.
ADDITIONAL MAILINGS
The designated company representative, listed above, receives a mailing as part of the dues payment.
Additional mailings to other employees of the company may be added at $30.00 each, annually. Please list
additional mailing(s) below.
Name ________________________________________ Name ____________________________________________
Address _______________________________________ Address __________________________________________
City___________________ State_____ Zip ___________ City____________________ State_____ Zip ____________
Phone (___) _____________ Fax (___) ______________ Phone (___) _______________ Fax (___) _______________
E-Mail Address__________________________________ E-Mail Address _____________________________________
Web Site URL ___________________________________ Web Site URL ______________________________________
FOR OFFICE USE ONLY:
Company ___________________ Master List_________________ Web Site_________________
Computer ______________ Rolodex Cards _______________ File Folder _________________ Dir. Add. _________________
Letter__________________ Kit Sent _____________________ Date Approved _____________
-OVER-
PETROLEUM EQUIPMENT, SUPPLYING OR SERVICING COMPANY
IN ORDER FOR US TO BE ABLE TO REFER YOUR SERVICES TO OUR MEMBERSHIP, PLEASE CHECK CATEGORIES THAT APPLY TO
YOUR BUSINESS FOR PUBLICATION IN THE BUYERS' GUIDE SECTION OF OUR MEMBERSHIP DIRECTORY AND OUR WEB SITE.
_____ Accounting
_____ Advertising/Public Relations
Laboratories
_____ Drug and Alcohol
_____ Petroleum Products
_____ Soil and Water
_____ Associations and Other Affiliations
_____ Leasing - Trucks, Tanks
_____ Automated Fueling
_____ Legal Services
_____ Business Appraisals and Brokers
_____ Lubricants Wholesaler (No Other Light Products)
_____ Business Forms and Office Supplies
_____ Maps
_____ Car Wash, Air and Vacuum Systems
_____ Petroleum Equipment Sales and Service
_____ Chemicals, Additives and Antifreeze
_____ Security Systems and Services
_____ Common/Contract Carriers
_____ Signs, Decals and Lettering
_____ Computer Products, Hardware and Software
_____ Spill Containment and Cleanup Services
_____ Convenience Store/Branding
_____ Spill Control Products and Supplies
_____ Convenience Store/Service Station
Design and Construction
_____ Convenience Store Supplies, Groceries
and Equipment
_____ Credit Reporting Services
_____ E-Commerce - Consumer/Marketer Fuel Sales
_____ Education and Training
_____ Electrical, Telephone, Natural Gas Provider
_____ Emergency Telephone Response Service (24 Hr.)
_____ Energy Management/Billing Services Consultant
_____ Engineering - Bulk Plant, SPCC Plans, SPR Plans
_____ Tank Trailers, Tank Trucks - New, Used,
Repair, Parts
Tanks, Aboveground Storage
_____ Certified Inspection
_____ Certified Installation and Removal
_____ Cleaning, Lining and Painting
_____ Disposal
_____ Sales
_____ Testing
Tanks, Underground Storage
_____ Certified Inspection
_____ Certified Installation and Removal
_____ Cleaning and Lining
_____ Disposal
_____ Sales
_____ Site Assessment
_____ Testing
_____ Financial
_____ Trucks - New, Used, Repair, Parts
_____ HVAC - Plumbing Contractors
_____ Waste Oil and Liquid Waste Removal
_____ HVAC - Plumbing Equipment and Supplies
Insurance
_____
_____
_____
_____
_____
Life, Disability
Liquid Fuel Tax Bonding
Pollution Liability
Property, Casualty, Automotive
Workers’ Compensation
RATES EFFECTIVE 1-1-14
Mjw 4/7/16 Membership-Applications-Associate