Application Form - Supplier Membership

Supplier Membership Application Form
Company Name*
Enter company name operating as
Street Address*
City*
Prov/State*
Postal/ZIP*
Main Phone*
Main Fax
Toll Free
Billing Address (if different from mailing)
Company email (for OTA Buyer's Guide)
example@example.com
Website URL
Number of Employees
DECLARATION:*

The information collected in this application will be published in our Buyers' Guide directory. If you wish your information to be added in the directory, please indicate by checking the box.From time to time, we make our membership list available to third-party companies to conduct industry surveys and questionnaires. If you would like to be included in this list, please indicate by checking the box.

Main Contact is the point of contact for membership. It is your responsibility to ensure the membership is in good standing every year. It is also your responsibility to ensure that the company information is kept up-to-date.
Name*
Title*
Email Address*
example@example.com
Direct Phone
Extension
Mobile Phone
Signature*

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National Suppliers can list up to four (4) locations to receive membership benefits from OTA as part of its annual membership. These locations will be listed as members of the association and will receive all membership priviledges as long as the primary membership is in good standing.
Office 1
Office 2
Office 3
Office 4

Dues Calculation
Membership Type options:

Local Supplier (conducts business within 160 km from base of operation)Provincial Supplier (conducts business throughout Ontario)National Supplier (conducts business throughout North America)Team OTA (Fee is $10,000. An OTA staff will call you)
Your annual dues is
National
Provincial
Local
Fees are pro-rated based on OTA's fiscal year which commences on January 1st. To determine your pro-rated fees payable with this application, select the current month from the dropdown below.
Select current month from drop down list*
Pro-rated membership dues
Logo Placement (Annual fee of $75.00)*

Yes, I would like our company logo placed in our listing in the OTA Buyer's GuideNo, not at this time
Note: For logo placement, an Illustrator vector eps format is required. Logo placement will auto-renew and billed at the beginning of each new OTA fiscal year until cancellation is received by OTA in writing.
Logo upload:

Cancelof
Sub-Total (dues+placement)
HST/GST (OTA HST # 107801003 RT0001)
Total due at time of application
Method of Payment

VisaAMEXMasterCard
To comply with the PCI DSS rules, OTA cannot ask for your credit card information. A member of our staff will give you a call to process payment by credit card.

Please provide the contact information below.
Name*
Phone No*
Cardholder email*
example@example.com
Cardholder signature*

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Should be Empty: