Membership Application

Store Information

Store Name (DBA):

Type of Retail Store:

Annual Sales Volume (NYS):

 

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.