Member - Florida Petroleum Marketers Association, Inc, FL

Business Information

Company Name: *

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Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category:

Employees:

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Physical Address

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Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

CATEGORY I: MARKETER MEMBERS: See fee schedule to determine the fee and enter it below.
CATEGORY II: ASSOCIATE SUPPORTER: $750.00
CATEGORY III: PATRONS: $3,500.00
CATEGORY IV: PATRON REFINER: $15,000.00
CATEGORY V: MAJOR SUPPLIER: See fee schedule to determine the fee and enter it below.
If using fee schedule, enter fee here:

Payment Option:

Bill me

Print Application

Pages

Members

Categories

Quicklinks

Events

Pages

Members

Categories

Quicklinks

Events

YOUR Association. Neighbors Serving Neighbors.

Pages

Members

Categories

Quicklinks

Events

Pages

Members

Categories

Quicklinks

Events

Member Application

Mailing Address

Address

Address

YOUR Association. Neighbors Serving Neighbors.