Allied Trades OTA Membership Application Form (2017/2018)

Company Name

Mailing Address

City Prov/State Postal

Main Phone Toll Free

Billing Address (if different from mailing)

DECLARATION: Please read carefully before completing form. By checking the appropriate box, you are giving OTA your consent to use the information as stated:

YOUR PRODUCTS & SERVICES (choose all that apply) Help OTA serve you better by telling us about your company. This information will be included in the online listing of the OTA Buyers' Guide: www.ontruck.org

Company Email (for OTA Buyer's Guide)

Number of Employees

Website URL

Main Fax

The information collected in this application form will be published in our on-line Buyers’ Guide directory. If you wish your information to be included in the directory, please indicate by checking the box.From time to time, we make our membership list available to third-party companies to conduct industry surveys and questionnaires. If you wish to be included in this list, please indicate by checking the box.

Choose the primary categories that generally defines the products/services you provide first then choose the sub-categories that clearly describes the services you provide for these products.

Primary Categories Sub-CategoriesAuction N/A

Cargo Securement (CSEC) N/A

Cleaning Equipment & Supplies (CES)

N/A

Consulting Services (CSER)

Legal

ComplianceFinanceTaxLaw Firm

Data Services (DSERV) CommunicationsInternetSoftware

Electrical (ELEC) N/A

Engines/Drivetrain (ENG) Components

Exhibit N/A

Fuel (FUEL) AdditivesFiltrationRefueling Service

Graphics (GR) N/A

Human Resources (HR) Recruitment

Insurance (INS) BrokerCarrier

Load Broker (LB) N/A

Maintenance (MAINT) Equipment

Material Handling (MH) N/A

Media (MED) CommunicationsPrinting ServicePublications

Primary Categories Sub-CategoriesPaints-Finishes-Coatings (PFC) N/A

Real EstateRecycling-Recovery-Waste System (RRW) Equipment

Refrigeration-Heating-Cooling (RHW)

SalesMaintenance

Safety Equipment-Security (SES)

ApparelService

Scales (SCL) N/A

Tires (TI)ManufacturerMaintenance-RepairsSales

Trailer-Tank (TT) AccessoriesComponentsLeasing-RentalsMaintenance-RepairsPartsManufacturerSales

Training (TRA) MaterialsSchool

Truck (TR) AccessoriesComponentsLeasing-RentalsMaintenance-RepairsPartsManufacturerSalesSleeper Cab & AccessoriesTracking

Truck Stops (TSTOP) N/A

Provide a brief description of your company's product and/or service offerings to the trucking industry

Main Contact

Email AddressTitle

Name Direct Phone

Mobile PhoneSignature

Choose Your Category

Method of Payment

Card Number Expiry

Cardholder

Card Holder SignatureCardholder Phone

Cardholder Email

Visa Amex MasterCard Cheque Enclosed

For OTA Use OnlyCheque/Auth # Amount Paid

Member ID Process DateMembership Period Processed By

Extension

Extension

Return your application and payment in an envelope marked "Confidential" to: Ontario Trucking Association | 555 Dixon Road, Toronto, Ontario M9W 1H8 | Phone: 416.249.7401 | Fax: 1.866.713.4188

Payment MUST accompany this application and are payable in Canadian Funds. Call OTA's Membership Department at 416.249.7401 for assistance.

Local: $675 (applies to you if your customers are within 160km. radius from your business address)

Provincial: $1,025 (applies to you if your customers are throughout the province of Ontario)

National: $1,775 (applies to you if your customers are throughout North America)

List All Branches/Dealers (These companies are encouraged to take out separate membership)

City Prov/State Phone Email

How to Calculate Your Dues Step1: Select current month Step 2: Select your Allied Trades Membership Category and your membership dues will be calculated automatically

A. Select current Month from drop-down listB. This is your annual Membership Dues =D. Your Pro-Rated Membership Dues: =

Logo Placement in Buyer's Guide & Printed Directory (DIRLOGO) =

E. HST/GST (HST #10780 1003 RT 0001) =

F. Total Membership Dues including HST =

Note about HST/GST: HST/GST is calculated based on the province your company is domiciled in. For companies domiciled in a US state, HST is 0.00.

Logo Placement- Please provide a Hi-Res EPS version only.

Team OTA: $10,000 (A value-added membership/sponsorship category applicable to any supplier. Click here for full details and how to apply)