| wha_membership_application_2016.doc |
WYOMING HOUSING ALLIANCE
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Firm Name: ____________________________________ Date____________
Wyoming Housing Alliance Business Address: ________________________________________________
P.O. Box 1493
Riverton, WY 82501 City:_______________________________ State: ______ Zip:____________
[email protected]
http://www.wyohousing.com Telephone: ___________________________Fax: ________________________
Contact Person:___________________________________ E-mail Address:_________________________________
Web Address:___________________________________________________________________________________________
Mailing Address if Different:_________________________________________________________________________
City:___________________________________ State:____________________ Zip:______________________
Sales Centers: What manufacturers' lines do you expect to carry this year?
____________________________________________________________________________________________
Enclosed is remittance in the amount of $275.00 for dues. Dues cover the period of
January 1, through December 31st of the current calendar year. Manufacturer floor
dues are an additional $75.00 per floor. Floor dues are to be paid monthly.
Our primary business is: ________________________________________________________________________