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 #*
As a new member, CAPA offers your first year of membership at $995.00. Below is the standard structure of dues, which will be the standard dues amount after your first year of membership. If you own multiple locations or have any questions, please reach out to Jacob Gray in membership at jgray@amgroup.us.

Regular Member Dues Structure:
- Primary Store with Loans $500-$1,000,000 - $1,595 annually
- Primary Store with Loans $1,000,001 - $2,000,000 - $1,895 annually
- Primary Store with Loans $2,000,000 and up - $2,495 annually
CAPA PAC:

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

Membership Dues:*

Special New Regular Member Dues

$995.00

Total

$0.00