National Vendor Membership Application
Annual Dues $500.00 (non refundable)
Please print out this page and type or print clearly in blue or black ink. Please fill
out all fields. Return your application along with the annual dues to the following address:
ADAD, Inc.
2065 Old
Montgomery Hwy
Birmingham,
AL 35244
General Information
Company_______________________________________________
Address________________________________________________
City_____________________________State______Zip_________
Business Phone______________________________
Fax#_______________________________________
Cell#_______________________Other#_____________________
E-Mail______________________________________
Owner/President________________________________________
# of Employees____________
You may list local sales representatives on the back if you would like.
Years in business___________
Type of Business, Products and/or Services offered:
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
By signing below, you attest that all information given in this application is true and accurate.
Signature_____________________________________________
Date_________________________________________________
