Membership Application

Please complete the form below to inquire about DPA membership.

* indicates required information

* I am a...

Distributor

Supplier

* Company Name:

Website:

* Contact Person:

Contact Person's Title:

* Email Address:

* Phone:

Fax:

* Address:

* City:

* State:

* Zip:

Approx. Annual Sales:

# of Years in Business:

# of Employees:

What product categories are you currently doing business in?

Janitorial/Sanitary Supplies (Can liners, Chemicals, Mops/Brooms, etc.)

Industrial Supplies (Tools, Fasteners, MRO, etc.)

Packaging Supplies (Cushioning, Shrink, Stretch, Tape, etc.)

Restoration Supplies (Dehumidifiers, Truck Mounts, Wands, etc.)

Safety Equipment & Clothing (Eye Protection, Gloves, Hi-Vis, etc.)

Public Safety (Fire Protection, Law Enforcement, EMS, etc.)

Other (describe below)

Are you a member of another buying group?

Yes

Which ones?

Comments:

Internal Comments:

For internal use only

Distributor Partners of America