Recommendation Form for New Retail Member
TAA Associate Contact Information
Company Name:
*
Contact Name
*
First Name
Last Name
E-mail
*
Phone Number
*
Format: (000) 000-0000.
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Recommendation of Retailer for TAA Membership
Retail Company Name:
City:
State:
Contact Name:
First Name
Last Name
Email:
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Website:
Rate the Retailer:
Rows
None
Weak
Average
Good
Excellent
Full-Service tobacconist
Active in their store
Timely accounting
Active in the industry
Personal Comments:
Complete Form
Should be Empty: