New Member Application

Instructions: Please fill out the application below and we will respond to you as soon as possible.*Required Field

Company Information

Mailing Information

Shipping Information

Business Info

Partnership        Corporation

- IF PARTNERSHIP

(Year) (State) - IF CORPORATION

List Share / Shockholders

Title:

Title:

Title:

References

*Contact:

Purchase History

Item Supplier Annual $ Purchased Discount
Industrial
Mats
Mops/Handles/Frames
Shop Towels
Kitchen Garments
Aprons
Linen Flatgoods
Healthcare Garments & Linens
Table Linens
Hangers
Chemicals/Detergents

Agreement

Membership is open to all textile rental companies that meet the following criteria: Members shall not be companies that have stock or securities listed on a nationally recognized securities exchange or have stock or securities traded over-the-counter; Members shall not have gross revenue in excess of $150,000,000; Members shall not have gross revenues less than $500,000; No member shall have been the subject of an adverse determination in any governmental suit, hearing, investigation or proceeding, or any private suit, alleging unfair or fraudulent sales and/or marketing practices on part of a member; Members must satisfy Central States Corporation credit standards.

* I understand that the information provided in this document is for the sole purpose of qualifying my company for membership in Central States Corporation and will be held in strict confidence. I believe this information to be accurate.