Membership Application - Connecticut Retail Merchants Association (CRMA)


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Membership Application

Name of Company
Primary Contact Name
Street Address
City
State
Zip or Postal Code
Telephone Number	Ex: (860) 555-1212
E-Mail Address
Fax Number	Ex: (860) 555-1212

Type of Business (check all that apply)
Apparel/Accessory
Home Entertainment
Department
Jeweler
Food Store
Pharmacy
Furniture Store
Shoe Store
Hardware Store
Restaurant
Auto Parts
Other (specify)

Non-Retail Member (Associates)
Number of Locations in Connecticut
Total Number of Employees