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Member Application
Business Information
Company Name:
*
Leave Blank:
Phone:
*
Website:
Email:
*
Business Description (200 char max):
*
Directory Category:
--- Select Primary Category ---
Accounting & Other Financial Services
All Other Business Support Services
All Other Specialty Trade Contractors
Asphalt/Concrete Services
ATM Sales & Service
Branding/Imaging
Building/Facility Maintenance
Bulk Plant Petroleum Storage Equipment
Business Associations
C-Store Beverage Supplier
Car Wash - Equipment/Supplies/Services
Commercial Banking
Common Carriers/Transporters
Construction & Renovation
Consulting Services
Convenience Store Retail
Convenience Store Services
Convenience Stores
Crude Petroleum and Natural Gas Extraction
Data Processing, Hosting, and Related Services
Electrical Services
Environmental & Remediation Services
Fuel Cleaning
Gasoline Stations with Convenience Stores
General/Convenience Store Supplier
Industrial Machinery and Equipment Merchant Wholesalers
Industry Supporters
Insurance Services
Legal Services
Majors
Manufacturer/Manufacturer Representative
Marketer
Petroleum and Petroleum Products Merchant Wholesalers (except Bulk Stations and Terminals)
Petroleum Bulk Stations and Terminals
Professional Services
Real Estate
Security
Signs, Canopies, Design & Lighting (including LED lighting)
Storage Tanks - Sales, Service & Cleaning
Tobacco Sales
Transporters
Vacuum/Air
Employees:
Full-time
Part-time
Business Keywords (enter a space between words):
*
Comments / Questions:
Brands:
# of C-Stores:
County:
# of Gallons Sold Per Year:
Physical Address
Line 1:
*
Line 2:
City:
*
State:
*
Postal Code:
*
Country:
*
--- Select Country ---
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Belgium
Belize
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Bolivia
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Botswana
Brazil
Brunei Darussalam
Bulgaria
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Cameroon
Canada
Caribbean
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China
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Ethiopia
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Finland
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Hong Kong SAR
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Israel
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Jordan
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Lao PDR
Latin America
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Lithuania
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Macao SAR
Macedonia (Former Yugoslav Republic of Macedonia)
Malaysia
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Mali
Malta
Mexico
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Mongolia
Montenegro
Morocco
Myanmar
Nepal
Netherlands
New Zealand
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Paraguay
Peru
Philippines
Poland
Portugal
Principality of Monaco
Puerto Rico
Réunion
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro (Former)
Singapore
Slovakia
Slovenia
Somalia
South Africa
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Tajikistan
Thailand
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
U.A.E.
Ukraine
United Kingdom
United States
Uruguay
Uzbekistan
Vietnam
Yemen
Mailing Address
Same as physical address
Line 1:
*
Line 2:
City:
*
State:
*
Postal Code:
*
Country:
*
--- Select Country ---
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Belgium
Belize
Bermuda
Bolivarian Republic of Venezuela
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Cambodia
Cameroon
Canada
Caribbean
Chile
China
Colombia
Congo [DRC]
Costa Rica
Croatia
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Greenland
Guatemala
Haiti
Honduras
Hong Kong
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea
Kuwait
Kyrgyzstan
Lao PDR
Latin America
Latvia
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia (Former Yugoslav Republic of Macedonia)
Malaysia
Maldives
Mali
Malta
Mexico
Moldova
Mongolia
Montenegro
Morocco
Myanmar
Nepal
Netherlands
New Zealand
Nicaragua
Nigeria
Norway
Oman
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Principality of Monaco
Puerto Rico
Réunion
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro (Former)
Singapore
Slovakia
Slovenia
Somalia
South Africa
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Tajikistan
Thailand
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
U.A.E.
Ukraine
United Kingdom
United States
Uruguay
Uzbekistan
Vietnam
Yemen
Social Networking:
Facebook
Twitter
Instagram
Primary Contact Information
First Name:
*
Last Name:
*
Title:
Phone:
*
Cell Phone:
Fax:
Email:
*
Contact Preference:
Email
Phone
Login:
*
Password:
*
Social Networking:
Facebook
Twitter
Instagram
Address
Same as Member Address
Line 1:
*
Line 2
City:
*
State:
*
Postal Code:
*
Country:
*
--- Select Country ---
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Belgium
Belize
Bermuda
Bolivarian Republic of Venezuela
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Cambodia
Cameroon
Canada
Caribbean
Chile
China
Colombia
Congo [DRC]
Costa Rica
Croatia
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Greenland
Guatemala
Haiti
Honduras
Hong Kong
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea
Kuwait
Kyrgyzstan
Lao PDR
Latin America
Latvia
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia (Former Yugoslav Republic of Macedonia)
Malaysia
Maldives
Mali
Malta
Mexico
Moldova
Mongolia
Montenegro
Morocco
Myanmar
Nepal
Netherlands
New Zealand
Nicaragua
Nigeria
Norway
Oman
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Principality of Monaco
Puerto Rico
Réunion
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro (Former)
Singapore
Slovakia
Slovenia
Somalia
South Africa
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Tajikistan
Thailand
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
U.A.E.
Ukraine
United Kingdom
United States
Uruguay
Uzbekistan
Vietnam
Yemen
Billing Contact Information
Same as Primary Contact
First Name:
*
Last Name:
*
Title:
Phone:
*
Cell Phone:
Fax:
Email:
*
Contact Preference:
Email
Phone
Login:
*
Password:
*
Social Networking:
Facebook
Twitter
Instagram
Address
Same as Member Address
Line 1:
*
Line 2
City:
*
State:
*
Postal Code:
*
Country:
*
--- Select Country ---
Canada
United States
Membership Options
Membership Package:
*
PETROLEUM MARKETER/JOBBER
:
See
fee schedule
to determine the fee and enter it below.
An independent business person/company who purchases gasoline, fuel oil, or other refined products from a refining company and resales the product. Often a jobber owns a bulk plant as well as gasoline stations or c-stores.
ASSOCIATE SUPPORTER
:
$750.00
An individual or company that supplies a product or service to the petroleum/c-store retail industry.
PATRONS
:
$3,500.00
An Associate Supporter is welcome to upgrade their membership to a Patron status. A Patron member believes support of Petroleum Marketer/Jobber members warrants extraordinary support of the Association. This membership may be approved by the Board of Directors.
PATRON REFINER
:
$15,000.00
If using fee schedule, enter fee here:
Payment Option:
Bill me
Charge my credit or debit card
Please scroll down to view the entire policy and then click Accept.
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privacy policy
of Florida Petroleum Marketers Association, Inc. I grant Florida Petroleum Marketers Association, Inc permission to contact me regarding my account, news, updates, and offers.
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