Company:   ________________________________________________________________

Address:  __________________________________________________________________  

City/State: ___________________________________________________ Zip  __________

Telephone: ________________________________________________________________

Facsimile: _________________________________________________________________

E-Mail: ____________________________________________________________________

Key Contact: _______________________________________________________________

Membership Dues - Annual Rates

	1 Warehouse	$ 600.00
	2-4 Warehouses	$ 800.00
	5+ Warehouses	$ 1,650.00

Mail this form with check payable to “NATO” or fax with credit card information to:

National Association of Tobacco Outlets 15560 Boulder Pointe Road Minneapolis , MN   55347 Fax:  952-934-7442

Credit Card:          VISA           MasterCard          Discover      American Express

Card Number:  _______________________________________  Exp. Date:  _____________

Signature:        ________________________________________________________________

Note: Pursuant to federal law, NATO is required to advise you that 30% of your annual membership dues are not tax deductible.