My Supplier Associate Membership Application

Transcription

1 Supplier associate: Any firm that is engaged in supplying goods that are used by the industry in the development or production of industry products and that is not eligible for producer membership. Complete this form to apply for your company s PCI supplier associate membership. Please print legibly to help us avoid errors. This form must be signed by an authorized agent of the company. PCI will hold all business-related information you provide in the strictest confidence. SECTION 1 CONTACT INFORMATION PCI will retain this information in its member database. The PCI primary contact you identify below will be your company s official contact person for PCI membership matters. This person will receive copies of all PCI membership-related correspondence and will be provided online access to directly maintain this information. COMPANY: POSTAL ADDRESS CITY/STATE/ZIP PHYSICAL ADDRESS (IF DIFFERENT THAN ABOVE; NO P.O. BOX) CITY/STATE/ZIP (IF DIFFERENT THAN ABOVE) BUSINESS PHONE WEBSITE URL FOR GENERAL INQUIRIES (e.g.: info@, sales@, marketing@, etc. If none exists, or the company has an online request form, leave this line blank.) THIS LOCATION IS A: CORPORATE HQ PLANT SATELLITE OFFICE OTHER PCI PRIMARY CONTACT (person to whom all membership issues should be addressed): POSTAL ADDRESS (IF DIFFERENT THAN ABOVE) CITY/STATE/ZIP PHONE PAGE 1 OF 5

2 PCI will calculate the annual dues as follows: SECTION 2 DUES CALCULATIONS AND PAYMENT PAYMENT REQUIRED WITH APPLICATION. Note: The PCI membership year begins July 1 and ends June Gross dollar sales (see definition on page 5) to the precast concrete structures industry in the previous calendar year. $ 2. Base dues (up to first $1,000, in gross sales) $ 2, Multiply all sales over $1,000,000 by.00086, up to a maximum of $12,500. For example, a company with $2,000,000 in sales would multiply $1,000,000 by for a total of $ $ 4. Add #2 and #3 (total should not exceed $15,000) Total annual dues $ Please check how your membership dues are being paid: Check included in U.S. funds drawn on a U.S. bank Charge my credit card: Visa Mastercard American Express Total Dues (from Line 4): $ CREDIT CARD NUMBER CVV# EXPIRATION DATE CARDHOLDER S CARDHOLDER S SIGNATURE SIGN AND SUBMIT FORM This form must be signed by an authorized agent of the member company. ON BEHALF OF THE COMPANY D IN SECTION 1, THE UNDERSIGNED: has reviewed, understands, and acknowledges the information and requirements set forth herein; affirms and attests to the accuracy of the information provided and the representations made by the company in this membership renewal form; and agrees that to the best of its ability, the company will maintain compliance with all of the requirements of PCI membership during the forthcoming membership year. OF MEMBER COMPANY AUTHORIZED AGENT DATE SIGNATURE PAGE 2 OF 5

3 SECTION 3 COMPANY PRODUCT INFORMATION PCI s website features a supplier associate search so that potential customers can find your company by name or product. Please check ALL THAT APPLY for the listing of your company s products on the website. ADHESIVES AGGREGATES ANCHORS & ACCESSORIES AUTOMATION CONTROLS BATCH PLANTS BATCHING & MIXING BEARING PADS BOLTS BOND BREAKERS BRIDGE PANEL DECK FORMING SYSTEMS BUILDING INFORMATION MODELING (BIM)/ DESIGN SOFTWARE BUILDING SYSTEMS CALIBRATION CAULK & SEALANTS CEMENT CHAIRS & SPACERS CHAMFERS CHEMICAL ADMIXTURES CHUCKS CLEANING PRODUCTS COATINGS/STAINS/PAINTS/SEALERS COMPUTER HARDWARE/SOFTWARE CONCRETE ACCESSORIES CONCRETE DELIVERY SYSTEMS & CONCRETE POURING MACHINES CONCRETE SAWING, DRILLING & CORING CONNECTORS/EMBEDS/INSERTS/HARDWARE CONSTRUCTION CHEMICALS CORNER GUARDS CORROSION INHIBITORS CORROSION PROTECTION SYSTEMS CRANES CURING COMPOUNDS & SYSTEMS CURING CYLINDER MOLDS DIAMOND CORE BITS DIAMOND TOOLS DUST CONTROL PRODUCTS/ EPOXIES EPOXY COATED PRESTRESSING STRAND/REBAR ERECTION /BRACING ERECTION HARDWARE EXPANSION JOINT SEALING SYSTEMS FORM LINERS FIBER REINFORCEMENT FORM RELEASE AGENTS & COATINGS FINISHING SUPPLIES & FORMING MACHINES FORMS/MOLDS GFRC FOR SPRAYING GFRC MATERIALS GRANITE GROUTS HARDENERS HARDWARE HOLLOW-CORE INSULATION PAGE 3 OF 5

4 SECTION 3 COMPANY PRODUCT INFORMATION (continued) INVENTORY CONTROL SYSTEMS LAB SUPPLIES LIFTING SYSTEMS & ACCESSORIES MAGNETS MANAGEMENT TOOLS MARBLE MATERIAL HANDLING MATERIAL RECYCLING/RECLAMATION SYSTEMS MISCELLANEOUS PALLETS PANEL PADS, PLASTIC PIGMENTS PLANT HEATING PRESTRESSING & ACCESSORIES REINFORCING STEEL POST-TENSION ANCHORS & ACCESSORIES PROJECT MANAGEMENT SOFTWARE REINFORCING STEEL CUTTING/ BENDING/FABRICATION POST-TENSIONING SYSTEMS REGLETS RELEASE AGENTS RETARDERS RIGGING ROLLER HOLD-DOWN DEVICES SAFETY SCALES SEALERS SHEATHING/STRAND DEBONDING SHIMS SIDE RAIL SYSTEMS SPLICING SYSTEMS/SPLICES STAINS STEAM GENERATORS STENCILS STRAND STRAND CHUCKS & ACCESSORIES SUPPLEMENTAL CEMENTING MATERIALS (SCMS) TESTING & LAB THIN BRICK TOOLS TRAILERS TRANSPORTING VIBRATORS & VIBRATION VOIDS BOX GIRDERS WELDING WIRE TIES & ACCESSORIES OTHER WELDED-WIRE FABRIC PAGE 4 OF 5

5 SECTION 4 SIGN AND SUBMIT Completion of this form and payment of membership dues are necessary to qualify for PCI membership. All figures on this statement are kept in the strictest confidence. 1. PRIMARY CONTACT FOR FINANCIAL ISSUES Verify that member company contact information is listed correctly. This information will serve as PCI s official record. PHONE 2. SIGN AND RETURN FORM This form must be signed by an authorized agent of the member company. ON BEHALF OF THE COMPANY D IN SECTION 1, THE UNDERSIGNED: has reviewed, understands, and acknowledges the information and requirements set forth herein; affirms and attests to the accuracy of the information provided and the representations made by the company in this document and in all attachments thereto; and agrees that to the best of its ability, the company will maintain compliance with all of the requirements of PCI membership for the duration of its membership. OF MEMBER COMPANY AUTHORIZED AGENT DATE SIGNATURE IMPORTANT DEFINITIONS GROSS DOLLAR SALES The total gross dollar sales volume, all plants, of goods, services, and information furnished to the precast concrete structures industry. SPECIAL DUES COMPUTATIONS Any company or subsidiary desiring separate PCI associate membership may file a separate sales declaration as a separate company and so state that it is not to be included in the parent company s declaration of sales. Separate membership rights and voting privileges are thereby accorded. Associate members located outside the United States compute dues based only on the gross dollar volume of sales within the United States. SUPPLIER S REPRESENTATIVE An independent individual or company selling only goods, services, and information produced by PCI supplier associate members. Importers and trading houses are not eligible for membership as manufacturers representatives, but may qualify as associate members. Manufacturer s representatives dues shall be $ annually. PAGE 5 OF 5