New England Service Station & Automotive Repair Association

Company:              ______________________________________________________________________  

Contact Name:      ______________________________________________________________________  

Address:                                ______________________________________________________________________ 

City/Town:            ___________________________________   State: ______________ 

Zip Code: _____________

Phone:     ______________________________ Fax:____________________________

Email:     ________________________________________________

Please mark (  [ ) the items that apply to your business:

Real Estate:           Own: ______        or            Lease: ______

Business Type:    Sole Proprietor _____         Partnership ____                 Corp ____

No. of Locations: _____     No. of Employees: ______      Full Time: _____  Part Time: ____

Repair Facility: _____         No. of Bays: _____             Auto Body: _____

Gas: ______                         Gas Brand: ______________________        Diesel: ____

Inspection Station: ____Towing: _____ C-Store: _____

Used Cars: _____ Car Wash: _____

Method of Payment (Annual Dues: $295)

Please make Check Payable to NESSARA

Check Enclosed: ______(if mailed)                  Check being mailed: ______(if faxed)

Credit Card No:  _________________________________________________________ Exp. Date ___________

(Mail or fax application to)

NESSARA Corporate Office

574 Boston Rd. Suite #12

Billerica, MA 01821

Phone:  978-667-7706            Fax:  978-667-4431