JAMAICA GASOLENE RETAILERS ASSOCIATION

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JGRA Membership Application Form

Re:  APPLICATION FOR MEMBERSHIP

i/We the undersigned do hereby apply to become a member of the Jamaica Gasolene Retailers Association, and if accepted, agree to be bound by and conform to its Constitution, By-Laws and regulations, its Code of Ethics and any contracts or agreements entered into on behalf of members.

E-mail

Expiry date of lease agreement/supply contract

Date business was established

Name:

Dealer/representative

Name of firm

Type of business

Partnership

Other

Name of Partner

Applicants business address

Applicants home address

Telephone Numbers

Office

Cell

Home

Fax

Dealer/representative

Type of business

Dealer-owned

Leased

Name and address of former dealer

Average Monthly Product sales

Former dealer

Current dealer

Litres

Litres