Tobacco Store, Grocery Store, Liquor Store Application

NATO

Tobacco Retailer Membership Application

Tobacco Store, Grocery Store, Liquor Store

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
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.