Alabama Grocers Association » Membership Application

Membership Application

Company Name (required)

Contact Name (required)

Title (required)

Address (required)

City (required)

State (required)

Zip Code (required)

Email Address (required)

Phone Number (required)

Fax Number

Classification (required)

Number of Stores (Retailer)

Annual Dollar Volume (Wholesaler)

Retail Classification

One store: $175.00

Each additional store: $ 50.00

Up to a maximum of: $2,000.00

Distributor, Broker, Manufacturer & Other Food Related: $500.00

Wholesale Classification: $1,300.00

Type of Payment (required)

Credit Card Number

Credit Card Expiration Date

Name on Card

Dues Amount

NOTE: All Information is strictly confidential and will not be released to anyone without your written authorization.

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