TIPA Membership Application

TIPA Membership Application
Company Name*
Other Company Alias
Primary Contact Name*

First NameMiddle NameLast Name
Primary Contact Title*
Primary Contact Email*
example@example.com
Secondary Contact Name*

First NameMiddle NameLast Name
Secondary Contact Title*
Secondary Contact Email*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Work Phone Number*

Country CodeArea CodePhone Number
Phone Number
Please enter a valid phone number.
International Phone Number
Please enter a valid phone number.
Company Website URL
Company Logo Upload

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Membership Classification

Review the membership types and make a selection.
PRODUCE HANDLER MEMBER
This category includes members who are shippers, importers, processors/fresh cut, produce brokers, wholesaler, distributor and/or grower. Dues are based on GROSS ANNUAL PRODUCE SALES - Make sure a selection in the Gross Annual Produce Sales option, below.

Minimum: $2,000 / Year
Maximum: $12,000 / Year

ALLIED INDUSTRY MEMBER
Retailer/Grocery StoresMaterial Provider—Includes members who are packaging, pallets, equipment, seeds, chemicals, stickers, post-harvest treatments, sanitation supplies.Service Provider—Includes members who are customs brokers, food safety, logistics, data collection, software, security, employee management and recruitment.

Dues: $1,800 / Year

MUNICIPAL/EDC MEMBER
This classification includes any city or county government entity.

Dues: $2,000 / Year
Select Membership Category*

Produce HandlerAllied IndustryMunicipal / EDC
Gross Annual Produce Sales
If Membership Classification is Produce Handler, make a selection to adjust the membership fee. This information will not be shared with anyone outside of TIPA.
Produce Handler Calculation
Information for Membership Directory
Branches/Seasonal Offices (City and State)
Brands (Produce Labels)
Personnel

Please list company Officials (President, Vice President, CEO, Etc.)

	Name	Title	Email Address
Official 1
Official 2
Official 3
Official 4
Official 5

Please list key personnel (Sales, Accounting, Food Safety, Etc.)

	Name	Title	Email Address
Personnel 1
Personnel 2
Personnel 3
Personnel 4
Personnel 5
Personnel 6
Personnel 7
Personnel 8
Personnel 9
Personnel 10

If you are a shipper or grower member, have you been third-party certified?

YesNo
If you answered Yes, please provide the Certifying Party/Agent(s) below.
Business Type (Please select all operations that apply)

3rd Party AuditingApplicatorAuditing - FinancialAuditing - Food SafetyBox/Container/Bag MfgBroker - CustomsBroker - ProduceBroker - TruckCertification ProviderChemicals - Mfg/SupplierCitrus Fund Raiser ShipperCitrus Gift-pack ShipperCity GovernmentCold StorageCommunicationsConsultantCross DockDomestic Shipper-PackerDry StorageEconomic Development (EDC)Fertilizer Mfg/SupplierFinancial ServicesFood ProcessorFood Safety Education/ConsultantFood Service DistributorFreight ForwardingGreenhouse EquipmentGrove Care OperatorGrower (Domestic)Ice & RefrigerationImplement/Forklift DealerIT ServicesInsuranceIrrigation EquipmentLabeling Equipment/LabelsLabor ContractorLegal ServicesMarketingMediaNurseryOffice Supply CompanyPacking/Sorting EquipmentPrinting CompanyProduce Importer/ShipperPromotion/AdvertisingRepackerRetail (Produce)Seed CompanyShipping SuppliesSoftwareStevedore CompanyTemperature MonitorsTransportationUniversityUtilityWholesale (Produce)Other
If you selected Cold Storage, please enter warehouse space below
Enter Sq. Ft. Space
Grower, Shipper, or Importer Commodities (Please check all applicable fruits/vegetables)

	Domestic	Imported
Aloe Vera
Asparagus
Avocados
Bananas
Banana Leaves
Beans
Beets
Blackberries
Blueberries
Broccoli
Bok Choy
Cabbage (Red, Green)
Cabbage (Napa)
Cactus Pears
Cactus Pods
Cantaloupe
Carrots
Cauliflower
Celery
Cilantro
Coconuts
Corn Husks
Corn (Sweet)
Cucumbers
Daikon
Dried Chilis
Eggplant
Garlic
Grapefruit
Greens
Guava
Herbs
Honeydew
Jicama
Kale
Leeks
Lemons

	Domestic	Imported
Lettuce
Limes (Key)
Limes (Persian)
Mangoes
Mushrooms
Okra
Onions
Onions (Green)
Oranges
Papayas
Parsley
Parsnips
Peas (Black Eyed)
Peas (Field)
Peaches
Pears
Pecans
Peppers (Bell)
Peppers (Chili)
Persimmons
Potaotes
Pumpkins
Radishes
Raspberries
Spinach
Squash
Squash (Chayote)
Strawberries
Sweet Potatoes
Tangelos
Tangerines
Tomatillo
Tomatoes
Turnips
Watermelon
Zucchini

Other:
NOTE: Payment Processing Fee is 3.5% of total payment. This is included in the total below.

Make Payment

USDTIPA Membership Fee

Payment Methods

Credit Card

Cash App Pay

ACH Bank Transfer

Should be Empty:

TIPA Membership Application

Membership Classification

Information for Membership Directory

Personnel

Grower, Shipper, or Importer Commodities (Please check all applicable fruits/vegetables)

Payment Methods