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Corporate
Membership
Application Form
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Print this application,
complete the form, and mail or fax to the address stated below.
Contact Information:
| First Name: |
Last Name: |
Middle Initial: |
| Mailing
Address: |
| City: |
State/Province: |
Postal Code: |
| Company
Name: |
|
Title (Accident
Reconstructionist, Engineer, etc.):
|
| Email
Address: |
| Web Site
Address: http:// |
| Phone: |
Fax: |
Other: |
| How
did you hear about the ARC Network? |
Company Information:
| Current
number of members or Employees: |
|
Short Description
of your Business:
|
Dues:
| Annual
Dues: |
$499 |
| Set
Up Fees (one-time charge): |
$50 |
| Additional
States (for expert dir.): qty ____ x $5 = |
$ |
| TOTAL |
$ |
Payment Type:
| Pay By
Check: |
Check
#: |
Amount:
$ |
| Pay By
Credit Card (circle one): |
MasterCard: |
VISA: |
| Credit
Card Number: |
| Expiration
Date: |
Name
on Credit Card: |
| Billing
Address: |
| City: |
State: |
Zip: |
Instructions:
To process your
application for membership, please include the following on floppy disk or
send via email:
-
Completed
"Basic"
applications for each employee you would like listed in the Expert Directory
(up to 5)
- Company logo or picture
(.gif or .jpg file format preferred or we can scan hard copy photos or
logos)
- Please send us a brochure
or any information you have describing your business. An ARC Network representative
will call you regarding setting up your web page and advertising.
Mail or FAX this application
along with the above information and your yearly dues to the following address:
The ARC Network
118 Lake Street South, Suite G
Kirkland, WA 98033
FAX:
(425) 284-2833
Email: arc@accidentreconstruction.com
After review
by the membership committee, you will be notified of your membership status,
be entered in the ARC Network Expert Directory, and your membership package
will be sent to you.
I certify
all the above information is true, correct and complete to the best of my knowledge.
I authorize the ARC Network to verify the above information and charge my credit
card (if paying by credit card).
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_________________________________
(signature)
|
_________________________________
(date)
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to membership information
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