| Application for HCA Membership
(Please type or
print)
Company Name _________________________________________________________
Contact Person __________________________________________________________
Work Phone ______________ Home Phone
______________ Fax # ______________
Mailing Address ___________________ City ______________
State ____ Zip _______
| Type of Operation |
|
|
 Self-Service |
Tunnel |
Rollover |
| High
Pressure Automatic |
Manufacturer |
Distributor |
Number of Locations _______________ Total
Number of Bays _______________
| Annual Dues for Calendar Year |
| $40
for Carwash Operators w/3 bays or less |
| $60
for Carwash Operators w/4-8 bays |
| $80
for Carwash Operators w/9-12 bays |
| $125
for Carwash Operators w/13 bays or more |
| $125
for Manufacturers or Distributors |
| |
| Make checks payable to: |
| Heartland Car Wash Association |
| P.O. Box 932, Des Moines, IA 50304 |
|
