To ensure a fast response, please complete all of the fields indicated below.

* Required fields

* Company Name:
* Street Address 1:
Street Address 2:
* City, State Zip:
* Phone Number:
Fax Number:
* Web URL (www.example.com):
* Email Address:
* Sales Tax ID (or VAT #):

* Name of Person Who Would Act as UNEDA Liaison:

Please list the products manufacturers you buy and sell (separate with commas):

* Have you been in business for at least six months? If not, will you be able to furnish a letter from your most recent employer endorsing your potential UNEDA membership? (YES/NO/LETTER)

* Do you have the endorsement of (at least) three current UNEDA members? If so, please list the companies and contact names. Additionally, please send them the attached UNEDA Reference Sheet and have then fill it out and emailed directly back to membershipcommittee@uneda.com. Company Contact 1. 2. 3.

* Are you aware that UNEDA has yearly dues of either $800USD (voting members) or $600USD (non-voting members)? (YES/NO)?:

* Do you anticipate being a voting or a non-voting member? (VOTING/NONVOTING):

How did you hear about UNEDA?:

What is your motivation for joining UNEDA?:

What added value would you bring to UNEDA?

* Do you have any outstanding complaints (complaints include bankruptcy, dealing in counterfeit equipment, outstanding balances, warranty issues or any other criminal complaints or legal encumbrances with any current UNEDA member? If yes, please explain:

* Are you aware that UNEDA has Code of Ethics, Membership Agreements and Constitutional documents that must be signed by and adhered to by all members? (YES/NO)

Please list all owners (more than 5%) of your company. Owner(s)

Please note that this is a preliminary application. All applications are reviewed first by the new membership committee, then the voting members of UNEDA, and finally a board vote. Your application may be denied during any of these steps without explanation.

Applications will take approx. one month to process. We will let you know within that time period if your application has been accepted or denied. At that time, we will forward you an invoice for either $800.00USD or $600USD and aforementioned documents that must be signed by a company officer and returned to UNEDA within 10 business days.

Thank you for applying to UNEDA! We hope to be trading with you very soon!

Regards,
UNEDA New Membership Committee