Membership Application Details
Please complete the following details for the business applying for membership
Note: Online Membership Subscription payment is by credit card only.
   

I wish to join as a Full Member.
I am not a retailer or wholesaler but would like to join as an Associate Member.
Details of Associate Membership can be found here

Legal or Company name of business
Trading name of business (if different)
Physical Address Shop no, building
Street
Suburb
Town/City
Region
Post Code
Postal Address (if different) Shop No, building
Street or PO Box
Suburb
Town/City
Region
Post Code
Website
Number of retail stores in this company
Average total annual turnover for all retail outlets
Please state your main product category
Please select an ANZSIC code for your main product category

Details of Primary Contact Person

Title
First Name
Last Name
Position
Phone Number
Mobile Number
Fax Number
Email Address

Details of Secondary Contact Person

Title
First Name
Last Name
Position
Phone Number
Mobile Number
Fax Number
Email Address

Reasons for Joining

 I would like to be contacted about the Westpac processing rates
Low -Importance- High
I am interested in joining the Association for the: Advisory Service
Cost-Saving Benefits
Lobbying/Government Representation
Events and Training
Retail Information (NZ Retail magazine, newsletters, website)
Other, please state