Team OTA Application Form

Company Name*
Full Name*

First NameLast Name
E-mail*
Cell Phone*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Provide a brief description of your company's product and/or service offerings to the trucking industry:*

0/200
Team OTA Annual Fee
prevnext( X )
Team OTA$10,000.00CAD

Subtotal $0.00CADTax $0.00CADTotal $0.00CAD
OTA Membership FeesSponsorship of the OTA Executive ConferenceSponsorship of the Baseball Day EventSponsorship of the Spring Golf TournamentSponsorship of the Fall Golf Tournament20% discount on all registration feesSpecial Recognition at sponsored EventsAttend the Bi-Annual Spring Board of Directors Retreat/Truckworld MeetingAttend the Exclusive Sponsors Reception and DinnerTeam OTA listing webpage on OTA’s websiteTeam OTA membership designation in company listing (print/digital)Common Membership Benefits: Membership listing, Buyers’ Guide, etc.
NowMonthlyQuarterly
Cal Value
Cal Value with HST
Your Quarterly Invoice Amount including tax will be:
CAD
Your Monthly Invoice Amount including tax will be:
CAD
Your One Time Invoice Amount including tax will be:
CAD
Company name, mailing address, telephone, fax, website to be provided on request by OTA Allied Trades (supplier) membersContact information for third parties who may be engaged by OTA from time to time to conduct industry surveys/questionnaires
VISAMaster CardAmerican ExpressCheque (will be mailed)
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.
Contact Name*
Phone Number

Area CodePhone Number
Extension
Signature*

Clear
Should be Empty: