Membership

To join NESSARA please print this page, complete the form and then mail it (with a check or Credit Card information) to the address below.

Application for Membership

Company: _______________________________________________
Name: _______________________________________________
Address: _______________________________________________
City/Town: _______________________________________________
State & Zip: _______________________________________________
Phone & Fax: _______________________________________________
Email: _______________________________________________
Business Type:  Sole Proprietor  ___  Partnership  ___  Corporation  ___
No. of Locations: ___  No. of Employees: ___  F.T.: ___  P.T.: ___
Real Estate:  Own ___  or Lease: ___  Repair Business Only: ___ 
No. of Bays: ___  Safety Inspection: ___  Emissions Certified: ___  
Towing: ___  C-Store: ___  Tobacco: ___  Car Wash: ___  Auto Body: ___
Gas Brand: ____________  Diesel: ___   F.S.: ___   S.S.: ___  Both: ___  

Please bill me:  Annually ____ 

Method of Payment  (Annual Dues:  $295)

Check Enclosed: _______  Credit Card (Visa Only): _______ 
Make checks payable to NESSARA

Credit Card No: _____________________________ Exp. Date: ______

Signature: ________________________________________________
image

Mail to: NESSARA, 574 Boston Road, Suite 12, Billerica, MA 01821
image

image