Application
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Organization Information (to be displayed online)
Organization Name
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Website
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Main Contact
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First Name
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Address 1
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City
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Email
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Additional Contacts
Contact 1
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Email Address
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Contact 2
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Email Address
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Contact 3
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Email Address
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Contact 4
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Email Address
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Contact 5
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Title
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Email Address
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Contact 6
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Title
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Email Address
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Contact 7
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Contact 8
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Email Address
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Contact 9
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Contact 10
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Email Address
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Add/Remove Contacts
Billing Address (if different)
Address 1
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Address 2
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City
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State
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PE
QC
SK
YT
AG
BN
BS
CH
CL
CM
CP
DF
DU
GR
GT
JA
MC
MR
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NA
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Postal Code/Zip
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Mailing Address (if different)
Address 1
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City
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State
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NE
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NM
NV
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OH
OK
OR
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RI
SC
SD
TN
TX
UT
VA
VT
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WV
WY
AB
BC
MB
NB
NL
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NU
ON
PE
QC
SK
YT
AG
BN
BS
CH
CL
CM
CP
DF
DU
GR
GT
JA
MC
MR
MX
NA
OA
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Postal Code/Zip
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About Your Company
Number of Full-Time Employees
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Number of Part-Time Employees
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Major line or franchise
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Additional lines carried
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Do you carry outdoor equipment?
No
Yes
Do you sell? (check all that apply)
Cars or trucks
ATVs or motorcycles
Boats
RVs
Snowmobiles
Please describe your sales mix
Agricultural equipment
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%
Construction Equipment
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%
Consumer Products
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%
Other
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%
Membership Investment
Membership Type
Select one...
Farm Equipment
Industrial Equipment
Outdoor Power Equipment
Hardware, Home Center, Lumberyard, Farm Store
Associate
Associate Hardware
Farm Equipment
Industrial Equipment
Outdoor Power Equipment
Associate
Number of Locations
Annual Membership Investment
Tax
Total
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Millions in Assets
Additional Items
Additional Categories Cost
One-Time Application Fee
Number of Full Time Employees
Number of Part Time Employees
Number of Rooms
Number of Seats
Number of Associates
Additional Directory Categories
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none
Primary Directory Category
None
Construction equipment dealer
Farm equipment dealer
Outdoor Power Equipment dealer
Vermeer Construction equipment dealer
Full-Time Employees
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Part-Time Employees
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Hotel/Motel Rooms
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Restaurant Seats
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Additional Associates
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Additional Associates Cost
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Additional Locations
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Additional Locations Cost
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Assets
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Assets Cost
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Additional Categories
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Number Of Additional Categories
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Additional Categories Cost
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Additional Item 1 Cost
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Additional Item 2 Cost
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Additional Item 3 Cost
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Additional Item 4 Cost
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Additional Item 5 Cost
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Additional Item 6 Cost
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Additional Item 7 Cost
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Additional Item 8 Cost
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Additional Item 9 Cost
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Additional Item 10 Cost
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Annual Dues (charged to card)
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Revenue Item
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Tax (charged to card)
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Fee (charged to card)
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Temp Value For DropDown 1
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MembershipType
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Additional Item 1
Additional Item 2
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Additional Item 9
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Payment Type
Credit Card
Check
NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.
Credit Card Information
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Credit Card Type
Mastercard
Visa
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Credit Card Number
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Name on Card
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Security Code
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Valid Through
01
02
03
04
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07
08
09
10
11
12
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
Address
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City
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State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
AG
BN
BS
CH
CL
CM
CP
DF
DU
GR
GT
JA
MC
MR
MX
NA
OA
PU
QE
QR
SI
SL
SO
TB
TL
TM
VE
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ZA
Outside US
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Postal Code/Zip
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Phone
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Credit Card Email Address
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