CAPA New Regular Member Application

CAPA New Regular Member Application
Company Name*
Owner/Main Contact*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Mobile Number
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pawn License #*
If you own multiple locations or have any questions, please reach out to Jacob Gray in membership at jgray@amgroup.us.
CAPA PAC:

Unless you mark this box, 30% of your annual dues will be made available to the CAPA PAC Fund.

Membership Dues:*

New License Regular Member Dues

within 3 years of 1st license

$995.00

Pawnshop A1 Regular Member Dues

Primary Store with Loans $1-$1,999,999

$1,595.00 Quantity

Pawnshop A3 Regular Member Dues

Primary Store with Loans $2,000,000 and up

$2,495.00 Quantity

Total

$0.00