Membership Application - PFMA

 

If you prefer to pay your membership by check, debit account or have an invoice sent, please download the application and mail it to PFMA.

 

Retail Membership Application
Make Pennsylvania's food industry voice stronger. Join today and shape the association's agenda on legislative and regulatory issues.

Associate Membership Application
Wholesalers and Suppliers of goods and services to the Retail Food Industry are invited to affiliate with the Pennsylvania Food Merchants Association. As an Associate Member of PFMA you join a prestigious group of suppliers enjoying the services and recognition provided by one of the nation’s largest and most respected food industry associations.

   
Membership Type: *
Company Information (to be displayed online)
Company Name *
T/A or DBA *
Business Address 1 *
Business Address 2
City *
County *
State *
Zip *
Phone *
Fax
Website
Email *
Main Contact
First Name *
Last Name *
Title
Address 1 *
Address 2
City *
County *
State *
Zip *
Phone *
Email *
Additional Contacts
Billing Address (if different)
Street
City
County
State
Zip
Mailing Address (if different)
Street
City
County
State
Zip
Additional Information
Briefly Describe your Product or Service
Principal Grocery Supplier
Type Of Operation
*Check all that apply
Supermarket
Convenience Store
Pharmacy
Superette
Delicatessen
Other           
Type Of Ownership
*Check all that apply
Sole Proprietor
Partnership
Corporation
LLC
Franchise
Independent
Chain
Total Annual Sales Volume of Pennsylvania Stores (Required)
Is This A Multi Unit Operation?
Yes
No
If Yes, Total Number of Units in PA
Total Number of Units in All States
Total Full Time Employees
Total Part Time Employees
Do Any Of Your Stores:
Accept Coupons
Perform Compliance Checks
Participate in a Scholarship Program
Do you have a relationship with any legislator that may assist the food industry in Pennsylvania? If yes, which legislator(s) and what relationship? (i.e. Governor, Friend)
Membership Investment
Primary Directory Category
Additional Directory Categories
**Hold CTRL on your keyboard to select multiple categories**
Annual Sales: *
(Amount with no symbols, spaces, or commas)
   
Total: $ 
   
Number of Full Time Employees:  
Number of Part Time Employees:  
Number of Rooms (Accommodations):  
Number of Seats (Restaurants):  
Number of Associates (Realtors, Attorneys):  
Number of Locations ($35/add. location):  
Enhanced Membership ($50):
$ 
$ 
$ 
*
NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.

The contents of this box are for testing purposes. This box will be removed when the form goes live.
Full-Time Employees
Part-Time Employees
Hotel/Motel Rooms
Restaurant Seats
Additional Associates
Additional Associates Cost
Additional Locations
Additional Locations Cost
Assets
Assets Cost
AdditionalCategories
Additional Categories Cost
NumberOfAdditionalCategories
additionalItem1Cost
Annual Dues (charged to card)
Tax (charged to card)
Fee (charged to card)
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Credit Card Information
Credit Card Type *
Credit Card Number *
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Credit Card Phone Number
Credit Card Email Address
Verification
I authorize PFMA to process my membership dues through the payment method selected. I understand my dues will be assessed at the prevailing rate based on my total annual sales volume for all units in Pennsylvania.
Please click submit only one time.  The transaction may take several seconds.

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