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WISCONSIN MILK HAULERS ASSOCIATION

APPLICATION

(Please fill the boxes below and then print the form and send it to the information below.)

Company Name
Contact Name
Title
Mailing Address
Street Address
City
State
Zip
Phone
Fax
Watts
Email
 
 
Annual Dues Schedule:
General division:    $225
Allied division:     $225
 

 Milk Hauler      Allied (please specify type of business)
                                

Payment options: Check enclosed Bill me Charge to my credit card (Visa/MC)

If you are charging your dues on your credit card, please enter your information in the boxes below.

Credit card#:
                        (Numbers only) 		Exp date:

*Please print this form out and either mail or fax it to:

Wisconsin Milk Haulers Assn
P.O. Box 44849
Madison, WI  53744-4849
Fax: (608) 833-2875

 

Copyright 1999
This page last updated: May 11, 2008