AMP - Hardware, Home Center, & Farm Store Members

Please complete this form to enroll the SouthWestern Association AMP Program. After the form has been completed and you click on the "send" button, this form will be transmitted to SouthWestern.

• AMP Program Information:

  Company Name
  Address
  PO Box
  County
  City
  State
  Zip
  Phone
  FAX
  Web address

• Wholesale affiliate:

• Secondary supplier(s)

• Number of employees:

  # of Full Time Employees
  # of Part Time Employees

• Branch location(s).  For each branch, list address, city, county, state and store manager:
  

  Address	City	County	State	Store Manager

• Business Organization
  Choose one of the following options:

  	Corporation
  	Partnership
  	Proprietorship
  	Other

• :

  		Name	E-Mail Address
  Owner
  Owner
  Manager
  Office Manager
  Credit Manager
  Business Forms
  Education/Training/Safety
  Human Resources
  Insurance
  Dept. Managers:

• Contact Person (if not owner)

  Name

  Title

• SouthWestern Association Member Services
  Please send me more information about the following industry-specific services available only to SouthWestern Association Members:

  Accounting Systems & Procedures	Management Incentive Programs
  Advertising Specialty Items	Marketing/Advertising
  ATS-GPS Theft Control on Equipment	Mergers/Acquisitions
  Bankcard Acceptance Program	On-site Programs
  Business Forms	Exit & Expansion Strategies
  Business Valuations & Operations Assessment	Financial Training and Education
  Computer & Technology Analysis & Integration	Aftermarket Development
  Convention/Annual Meeting	Leadership & Management Training
  Credit/Lein Manuals [State:	Customer Service Training
  Credit Reporting Services	Professional Selling Skills
  Dealer to Dealer Programs	Succession/Operational Cross Training
  Drug & Alcohol Testing Programs	Regulatory Compliance
  Employee & Management Benefit Program	Retirement/401(k), Profit Sharing
  Employee Policy & Procedure Manuals	Seminars
  Estate Planning	Web Site Development
  Group Health, Life & Business Insurance	Other
  Legal Services

• Insurance Coverage - SouthWestern Association offers significant savings to members on a number of insurance products.  Please complete the information below to help us serve you:
  Please list current Insurance provider and next renewal date:

Coverage	Current Provider	Next Renewal Date
Group Health (must have 2 or more eligible)
Worker's Compensation
General Liability
Property & Casualty
Dental
401(k) and Profit Sharing
Other:

• Computer Systems

  Hardware
  	Computer brand, make, model, i.e. Toshiba Tcra 8000
  Software
  	For example: MS Office 2000, Quick Books 2000, etc