Supplier Membership Form
PRIMARY CONTACT INFORMATION
Company Name
*
DBA
PRIMARY CONTACT
*
First Name
Last Name
PRIMARY CONTACT PHONE
*
Please enter a valid phone number.
FAX NUMBER (IF APPLICABLE)
Please enter a valid phone number.
PRIMARY CONTACT EMAIL ADDRESS
*
example@example.com
PRIMARY CONTACT ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SELECT PREFERRED METHOD OF COMMUNICATION
*
Please Select
EMAIL
POSTAL MAIL
FAX
SECONDARY CONTACT (IF APPLICABLE)
SECONDARY CONTACT INFORMATION - Please list name, email and phone number.
Check if address of secondary contact is the same as primary. If not - please add secondary contact's address below.
SAME AS ABOVE
Other
BUSINESS CATEGORY
My company falls into the following category:
*
Producer/Propane Supplier
Manufacturer/Distrubuter
Service Provider
I currently hold a Category
Category
license (if applicable).
Payment
Payment/Invoice
TPGA's accountant will invoice you for membership dues. Once payment has been confirmed/received, a confirmation email will be sent to you to acknowledge membership.
How did you hear about TPGA?
How did you hear about TPGA?
*
TPGA Website
TPGA Publication
TPGA Staff
Facebook
Instagram
Linked-In
PSC Purchase
Referred by TPGA Member - Please list member name
Submit
Should be Empty: