NATO
Convenience Store/Chain Store Application
Company
Address
City
State
Zip
Telephone
Fax
Email
Key Contact
Annual Membership Dues
Dues:
- $125.00 for One Store or First Store
- $30.00 for Each Additional Store
- More than 100 Store Locations Capped at $3,200.00
Total Number of Stores:
Total Dues Amount:
$125.00
Payment
Type
Mail this form with check payable to "NATO" to:
National Association of Tobacco Outlets
c/o Kleinfeld Kaplan & Becker
1850 M Street NW, Suite 1000
Washington, DC 20036
National Association of Tobacco Outlets
c/o Kleinfeld Kaplan & Becker
1850 M Street NW, Suite 1000
Washington, DC 20036
Card Type
Card #
Exp. Date
Billing Address
City
State
Zip
Signer's Name on Card
Signature
Fax this form to: 952-487-0123 or Email to: david.spross@natocentral.org
Note: If you own more than one store, please return a store list with your application since all store locations will be matched to state and Congressional legislative districts.
Pursuant to federal law, NATO is required to advise you that 40% of your annual membership dues are not tax deductible.