Associate Member Application

Company*
Company Representative Name & Title (Name to be shown in Directory)*
Street Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Fax
Email
Website
Mailing address is different than street address above
- Yes
- No
Mailing Address
Street Address Address Line 2 City State ZIP Code
ADDITIONAL MAILING ADDRESSES
The designated company representative, listed above, receives a mailing as part of the dues payment. Additional mailings to other employees of the company may be added at $30.00 each, annually. Please list additional mailing(s) below.
I would like to add an additional mailing address
- Yes
- No
Company Representative 2*
First Name Last Name
Mailing Address*
Street Address Address Line 2 City State ZIP Code
I would like to add a third mailing address
- Yes
- No
Company Representative 3*
First Name Last Name
Mailing Address*
Street Address Address Line 2 City State ZIP Code
I would like to add a fourth mailing address
- Yes
- No
Company Representative 4*
First Name Last Name
Mailing Address*
Street Address Address Line 2 City State ZIP Code
I would like to add a fifth mailing address
- Yes
- No
Company Representative 5*
First Name Last Name
Mailing Address*
Street Address Address Line 2 City State ZIP Code
I would like to add a sixth mailing address
- Yes
- No
Company Representative 6*
First Name Last Name
Mailing Address*
Street Address Address Line 2 City State ZIP Code
I would like to add a seventh mailing address
- Yes
- No
Company Representative 7*
First Name Last Name
Mailing Address*
Street Address Address Line 2 City State ZIP Code
I would like to add a eighth mailing address
- Yes
- No
Company Representative 8*
First Name Last Name
Mailing Address*
Street Address Address Line 2 City State ZIP Code
I would like to add a ninth mailing address
- Yes
- No
Company Representative 9*
First Name Last Name
Mailing Address*
Street Address Address Line 2 City State ZIP Code
I would like to add a tenth mailing address
- Yes
- No
Company Representative 10*
First Name Last Name
Mailing Address*
Street Address Address Line 2 City State ZIP Code
PETROLEUM EQUIPMENT, SUPPLYING, OR SERVICING COMPANY INFORMATION

IN ORDER FOR US TO BE ABLE TO REFER YOUR SERVICES TO OUR MEMBERSHIP, PLEASE CHECK CATEGORIES THAT APPLY TO YOUR BUSINESS FOR PUBLICATION IN THE BUYERS' GUIDE SECTION OF OUR MEMBERSHIP DIRECTORY AND OUR WEBSITE.
Please check all categories that apply to your business
- Accounting
- Advertising/Public Relations
- Associations and Other Affiliations
- Automated Fueling
- Business Appraisals and Brokers
- Business Forms and Office Supplies
- Car Wash, Air, and Vacuum Systems
- Chemicals, Additives, and Antifreeze
- Common/Contract Carriers
- Computer Products, Hardware and Software
- Convenience Store/Branding
- Convenience Store/Service Station Design and Construction
- Convenience Store Supplies, Groceries and Equipment
- Credit Reporting Services
- E-Commerce - Consumer/Marketer Fuel Sales
- Education and Training
- Electrical, Telephone, Natural Gas Provider
- Emergency Telephone Response Service (24 Hr.)
- Energy Management/Billing Services Consultant
- Engineering - Bulk Plant, SPCC Plans, SPR Plans
- Financial
- HVAC - Plumbing Contractors
- HVAC - Plumbing Equipment and Supplies
- Insurance - Life, Disability
- Insurance - Liquid Fuel Tax Bonding
- Insurance - Pollution Liability
- Insurance - Property, Casualty, Automotive
- Insurance - Workers' Compensation
- Laboratories - Drug and Alcohol
- Laboratories - Petroleum Products
- Laboratories - Soil and Water
- Leasing - Trucks, Tanks
- Legal Services
- Lubricants Wholesaler (No Other Light Products)
- Manufacturer - HVAC Equipment
- Maps
- Marine Fuel Wholesale
- Petroleum Equipment Sales and Service
- Propane Marketers
- Security Systems and Services
- Signs, Decals, and Lettering
- Spill Containment and Cleanup Services
- Spill Control Products and Supplies
- Tank Monitoring
- Tank Trailers, Tank Trucks - New, Used, Repair, Parts
- Tanks, Aboveground Storage - Certified Inspection
- Tanks, Aboveground Storage - Certified Installation and Removal
- Tanks, Aboveground Storage - Cleaning, Lining, and Painting
- Tanks, Aboveground Storage - Disposal
- Tanks, Aboveground Storage - Sales
- Tanks, Aboveground Storage - Testing
- Tanks, Underground Storage - Certified Inspection
- Tanks, Underground Storage - Certified Installation and Removal
- Tanks, Underground Storage - Cleaning and Lining
- Tanks, Underground Storage - Disposal
- Tanks, Underground Storage - Sales
- Tanks, Underground Storage - Site Assessment
- Tanks, Underground Storage - Testing
- Technology Services
- Trucks - New, Used, Repair, Parts
- Waste Oil and Liquid Waste Removal
Additional Mailings ($30 each)
Extra Mailings Price
Total Dues
Price: $0.00
Total
$0.00
Choose your payment method:
- Invoice Me
- Pay Now
Credit Card

American Express
Discover
MasterCard
Visa
Consent*
By typing my name below I am consenting that this is my electronic signature and grant PPA the permission to use the information above. The information in the above form is completed and true to the best of my knowledge.*
Electronic Signature*
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Associate Members are firms that supply active members with petroleum products and other related services and products.

Download Associate Member Membership Application PDF

Associate Member Application

Associate Member Application

ADDITIONAL MAILING ADDRESSES

PETROLEUM EQUIPMENT, SUPPLYING, OR SERVICING COMPANY INFORMATION