Membership Application

Store Information

Store Name (DBA):

Type of Retail Store:

Annual Sales Volume (NYS):
--- Up to $300,000$300,001 to $500,000$500,001 to $750,000$750,001 to $1,000,000$1,000,001 to $1,500,000$1,500,001 to $2,000,000$2,000,001 to $2,500,000$2,500,001 to $3,000,000

Note: Please contact us if your annual sales volume exceeds $3M

Number of Stores in New York:

Website Address:

Corporate Name:

Street Address:

City:

State:

Zip:

Contact Information

First Name:

Last Name:

Title:

Telephone:

Fax:

Email:

I hereby apply for membership in and agree to contribute to the support of the Retail Council of New York State.