Movability Membership Application

ORGANIZATION NAME*

TOTAL NUMBER OF EMPLOYEES*

SELECT MEMBERSHIP LEVEL*

The membership fee is based on the number of employees and employer has in Central Texas.

MAILING ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

MY PHYSICAL ADDRESS IS THE SAME AS MY MAILING ADDRESS*

PHYSICAL ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

NUMBER OF LOCATIONS IN CENTRAL TEXAS (BASTROP, BURNET, CALDWELL, HAYS, TRAVIS & WILLIAMSON COUNTIES)

Primary Contact

NAME*

EMAIL*

example@example.com

TITLE/ROLE

WORK PHONE*

MOBILE PHONE

Accounts Payable/Accounts Receivable Contact

NAME*

EMAIL*

example@example.com

TITLE/ROLE

WORK PHONE*

MOBILE PHONE

HOW DID YOU HEAR ABOUT MOVABILITY?

IF A COLLEAGUE OR FRIEND REFERRED YOU, PLEASE LET US KNOW THEIR NAME SO WE CAN THANK THEM!

TYPE OF ORGANIZATION: (SELECT ALL THAT APPLY)*

TELL US A LITTLE MORE ABOUT WHY YOU ARE JOINING MOVABILITY (SELECT ALL THAT APPLY)*

We want help from Movability to implement employee mobility programsWe want networking opportunities with other companiesWe want recognition for reducing our traffic footprintTo attract & retain talentTo promote environmental sustainabilityTo save moneyTo support Movability's missionOther

If you selected OTHER, please explain.

UPLOAD COMPANY LOGO

(To include on our website)

PAYMENT OPTIONS

HOW WOULD YOU LIKE TO PAY FOR YOUR MEMBERSHIP? Please be sure to check the box indicating you are not a robot and then hit submit. Do not close the webpage until you see a thank you page confirming your application has been submitted or your information will be lost. Thank you!*

Online via credit card (processing fee required)Check (payable to Movability, Inc. 535 E. 5th Street, Austin, TX 78701)Send me an invoice (this option allows for credit card payments; payment is due within 15 days of invoice receipt)

Membership Level & Payment*

Small Membership- Annual Billing Option

For organizations with 2-49 employees

$200.00

Small Membership- Monthly Billing Option

This membership level is paid in monthly installments of $20.00 for 12 months. For organizations with 2-49 employees. This option requires a card on file to enable automatic payments.

$20.00

Medium Membership- Annual Billing Option

For organizations with 50-199 employees

$400.00

Medium Membership- Monthly Billing Option

This membership level is paid in monthly installments of $40.00 for 12 months. For organizations with 2-49 employees. This option requires a card on file to enable automatic payments.

$40.00

Large Membership- Annual Billing Option

For organizations with 200-499 employees

$800.00

	Quantity	Price
Employer		$800.00
Service Provider		$560.00
Nonprofit		$400.00

Large Membership- Monthly Billing Option

This membership level is paid in monthly installments for 12 months. For organizations with 200-499 employees. This option requires a card on file to enable automatic payments.

$80.00

	Quantity	Price
Employer		$80.00
Service Provider		$55.00
Nonprofit		$40.00

Enterprise Membership- Annual Billing Option

For organizations with 500-999 employees

$1,600.00

	Quantity	Price
Employer		$1,600.00
Service Provider		$1,120.00
Nonprofit		$800.00

Enterprise Membership- Monthly Billing Option

This membership level is paid in monthly installments for 12 months. For organizations with 500-999 employees. This option requires a card on file to enable automatic payments

$160.00

	Quantity	Price
Employer		$160.00
Service Provider		$110.00
Nonprofit		$80.00

Global Membership- Annual Billing Option

For organizations with 1,000+ employees

$2,400.00

	Quantity	Price
Employer		$2,400.00
Service Provider		$1,680.00
Nonprofit		$1,200.00

Global Membership- Monthly Billing Option

This membership level is paid in monthly installments for 12 months. For organizations with 1,000+ employees. This option requires a card on file to enable automatic payments.

$240.00

	Quantity	Price
Employer		$240.00
Service Provider		$160.00
Nonprofit		$120.00

Total

$0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Credit Card Processing Fee:

Total:

I authorize Movability to renew my membership on my renewal date each year. I understand and agree that the associated charges for the renewal may be processed using the payment method currently on file unless otherwise specified. You can change this answer at any time during your membership.*

Yes, please auto-renew my membership until instructed to do differently.No, please invoice me when it is time to renew my membership

Please verify that you are human*