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Company Name:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:

Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:

Company E-Mail:
Website URL:
Year Company Founded:

Products Manufactured:

Registered Trade Names:

Product Liability Coverage:
Name of product liability insurer or bonding company in North America:
Limit of liability or amount of bond:

Type of Ownership:
 Individual Ownership
 Corporation
 Partnership

Methods of Distribution:
 Wholesalers
 Agents
 Direct-to-Retailer
 Cooperative
 Direct-to-Consumer
 OEM
 Other:

Areas of Distribution:
 North America
 Central America
 South America
 Europe
 Asia
 Africa
 Australia

Company Officers:
Officer #1:Title:
Officer #2:Title:
Officer #3:Title:

Your Company's Prime Contact for Association in North America:
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Email:

Who Suggested Membership? (Not required for membership)
Name:
Company:

Annual Sales:
 Foreign Membership - Annual Ag Sales under $1 Million
 Foreign Membership - Annual Ag Sales $1-3 Million
 Foreign Membership - Annual Ag Sales $3-6 Million
 Foreign Membership - Annual Ag Sales over $6 Million