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    NATSOInc
    The document is a membership application for NATSO. It provides information on how to apply for NATSO membership through fax, mail, phone or online. It requests corporate contact information, location details, and services provided to determine membership eligibility. Completing and submitting the form allows the applicant to join NATSO and utilize membership benefits.

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    PHP VTZ AQd

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    NATSOInc
    36 views2 pages
    The document is a membership application for NATSO. It provides information on how to apply for NATSO membership through fax, mail, phone or online. It requests corporate contact information, location details, and services provided to determine membership eligibility. Completing and submitting the form allows the applicant to join NATSO and utilize membership benefits.

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    The document is a membership application for NATSO. It provides information on how to apply for NATSO membership through fax, mail, phone or online. It requests corporate contact information, location details, and services provided to determine membership eligibility. Completing and submitting the form allows the applicant to join NATSO and utilize membership benefits.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    36 views2 pages

    PHP VTZ AQd

    Uploaded by

    NATSOInc
    The document is a membership application for NATSO. It provides information on how to apply for NATSO membership through fax, mail, phone or online. It requests corporate contact information, location details, and services provided to determine membership eligibility. Completing and submitting the form allows the applicant to join NATSO and utilize membership benefits.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    NATSO MEMBERSHIP APPLICATION

    o YES, I WANT TO JOIN NATSO!

    ___________________________________________________________________________________________________ EASY WAYS TO SIGN UP


    Corporate Name FOR MEMBERSHIP TODAY:
    ___________________________________________________________________________________________________ FAX this form to: (703) 684-4525
    Mailing Address
    MAIL this form to:
    ___________________________________________________________________________________________________ NATSO
    City State Zip
    PO Box 758739
    ___________________________________________________________________________________________________ Baltimore, MD 21275
    Shipping Address (if mailing address above is a P.O. Box)
    SIGN UP IMMEDIATELY BY CALLING
    ___________________________________________________________________________________________________
    City State Zip KIMBERLY ROBERTS, (703) 739-8573.

    ___________________________________________________________________________________________________ ONLINE Sign up online at


    Website www.natso.com/join

    Please list a reference who is a travel plaza or allied member of NATSO:


    ____________________________________________________________________________ __________________________________________________________________________
    Company Name Contact Name

    PRIMARY CONTACTS
    Corporate Contact #1 (Important Note: This individual will also serve as Corporate Contact #2
    the voting contact for the association, and must possess an ownership ____________________________________________________________________________
    interest in the company and be actively involved in its operation.) Contact Name Title
    ____________________________________________________________________________ ____________________________________________________________________________
    Contact Name Title Phone Fax
    ____________________________________________________________________________ ____________________________________________________________________________
    Phone Fax E-mail Address
    ____________________________________________________________________________ ____________________________________________________________________________
    E-mail Address Mailing Address (if different than above)
    ____________________________________________________________________________ ____________________________________________________________________________
    Mailing Address (if different than above) City State Zip
    ____________________________________________________________________________ Im interested in signing up for a NATSO committee.
    City State Zip
    Please send me additional information.
    Im interested in signing up for a NATSO committee.
    Please send me additional information. If you have additional contact names, please list them on a separate sheet of paper.

    LOCATION INFORMATION (Please copy and complete for additional locations)


    ____________________________________________________________________________ Location Contact #2
    Location Name
    ____________________________________________________________________________
    ____________________________________________________________________________ Contact Name Title
    Mailing Address
    ____________________________________________________________________________
    ____________________________________________________________________________ Phone Fax
    City State Zip
    ____________________________________________________________________________
    ____________________________________________________________________________ E-mail Address
    Shipping Address (if mailing address above is a P.O. Box)
    ____________________________________________________________________________
    ____________________________________________________________________________ Mailing Address (if different than above)
    City State Zip
    ____________________________________________________________________________
    ____________________________________________________________________________ City State Zip
    Highway/Roadway Location and Exit Number, if Applicable
    Im interested in signing up for a NATSO committee.
    Location Contact #1 Please send me additional information.
    ____________________________________________________________________________
    Contact Name Title CHECK ONE:
    ____________________________________________________________________________ This location is a franchise of ___________________________________
    Phone Fax
    This location is independently-operated
    ____________________________________________________________________________
    E-mail Address This location is part of a chain (company name) ______________________
    ____________________________________________________________________________ ______________________________________________________________________
    Mailing Address (if different than above)
    ____________________________________________________________________________
    City State Zip
    Im interested in signing up for a NATSO committee.
    Please send me additional information.
    CHECK-LINK
    I want to start using the NATSO Check-Link check verification program right away at this location!
    Please connect this location through the following equipment:

    Trendar ID # _______________________________________________________________________Comdata Stripe Reader ID # ___________________________________________________

    This location is: Open now Opening on this date: _________________________

    LOCATION SERVICES (Please check all services that you provide at this location.)
    125 parking spaces Dolly down area Idle reduction/ Public fax
    2675 parking spaces Dentist electrification equipment Scales
    76+ parking spaces E-85 Laundry Secured parking
    24-hour restaurant Electric charging stations for vehicle Local police patrol Separate on premise
    ATM machine Emergency road service Loadboard convenience store
    Barber/salon Exercise facilities Lounge Security patrol
    Biodiesel Fast food restaurant Major credit cards accepted Telecommunication services
    Buses welcome Fenced parking NATSO Check-LinkTM Tire repair/oil change
    Check guarantee service FedEx service Medical Trailer washout
    Church services Free parking Onsite hotel/motel Travel store/convenience store
    CNG/natural gas stations Food court Overnight parking Truck repair
    Daily parking Handicapped accessible Paid parking Truck wash
    DEF at the fuel islands Hazmat parking Paved parking US Postal Service
    Deli/snack bar Internet access Propane stations UPS service
    Private showers Unpaved parking

    NATSO FAIR SHARE DUES SCHEDULE


    NATSO dues are based on a fair share principle meaning that travel plaza and truckstop locations pay dues annually based on the
    amount of diesel fuel sold. Calculate your investment based on total gallons of diesel fuel pumped per year at your location:
    Less than 1.2 million gallons per year or less than 100,000 per month ............$830 6 million to 8 million gallons per year or 500,000 to 660,000 per month .........$1,995
    1.2 million to 2 million gallons per year or 100,000 to 167,000 per month ......$1,065 8 million to 9 million gallons per year or 660,000 to 750,000 per month .........$2,225
    2 million to 4 million gallons per year or 167,000 to 330,000 per month .........$1,180 9 million to 10 million gallons per year or 750,000 to 834,000 per month .......$2,455
    4 million to 6 million gallons per year or 330,000 to 500,000 per month .........$1,760 Over 10 million gallons per year or more than 834,000 per month..................$2,800

    Tax-Deductible Donation to The NATSO Foundation (optional)* $100


    2017 NEW
    One quarter of Check-Link $90
    MEMBER SPECIAL
    Flat rate of $830 for the first year only! TOTAL: $ ____________
    *This amount is tax deductible

    METHOD OF PAYMENT
    Check Enclosed
    Credit Card: MasterCard Visa American Express Discover
    _____________________________________________________________________________________________________________________________________________________________
    Credit Card Number Expiration Date
    _____________________________________________________________________________________________________________________________________________________________
    Name on Credit Card Billing Zip Code
    _____________________________________________________________________________________________________________________________________________________________
    Signature

    As a member of NATSO, I agree to abide by the bylaws of the association, and to represent the highest possible standards. I also pledge to work
    actively to enhance the image of the travel plaza and truckstop industry.
    _____________________________________________________________________________________________________________________________________________________________
    Signature Date

    IMPORTANT NOTICES:
    Pursuant to the Omnibus Budget Reconciliation Act of 1993, 85.66 percent FOR NATSO USE ONLY
    of your dues are not tax-deductible as they are used for lobbying purposes.
    Dues are not deductible as a charitable contribution for federal income tax Amount Paid ____________________ Date Paid _______________________
    purposes, but a portion may be deductible as a business expense.
    Check # ________________________ Credit __________________________

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