AIWD Prospective Member Information Form

All information provided will be kept confidential by the AIWD Executive Committee
Company Name:   
Address:    City:    State:    Zip:   
Contact Name:    Title:   
Phone:    Email:    URL:   

Please answer the following questions by checking either Y (Yes) or N (No)
Does your company sell welding supplies, welding machines, & related hardgoods? Y: - N:
Do you repair Welding Equipment ? Y: - N:
Do you have a CO2 Bev. Carb business ? Y: - N:
Does your company sell safety supplies? Y: - N:
Does your company sell hand tools? Y: - N:
Does your company sell Industrial Gases? Y: - N:
Does your company sell Specialty Gases? Y: - N:
Who supplies your Gases?
Does your company fill specialty gas cylinders? Y: - N:
Does your company fill industrial gas cylinders? Y: - N:
Do you wish to become a member of AIWD? Y: - N:
Are you a member of a buying group? Y: - N:
If Yes, which one(s):

Please answer the following questions:
How long has your company been in business?    Years Number of employees:   
What is your company‚Äôs ownership structure?   
Approximate annual revenue $    % Sales mix:   Gas & Rent: % Hardgoods:   % Other:   %
Number of facilities (Main office, branches):    Please list the cities/towns:   
Please check and/or add who your core vendors are:    Lincoln    Miller    ESAB    Hypertherm    Hobart
Plase list any other core vendors:   
Please describe the geography that your company serves (e.g., state(s), county(ies), radius around a city/town):
Please describe the benefits you seek from the AIWD:

Membership
Membership is open to welding supply and industrial gas distributors that meet the following criteria: Members shall not be companies that have stock or securities listed on a nationally recognized securities exchange or have stock or securities traded over-the-counter; Members shall not have gross annual revenue in excess of $250,000,000; Members shall not have gross annual revenue less than $500,000; Members shall have been in business for more than two consecutive years. Acceptance and membership is subject to AIWD By-Laws and Rules & Regulations.

By this form, I understand that the information provided here is for the sole purpose of applying for membership in the AIWD, Inc., and that it will be held in strict confidence. I believe this information to be accurate. I also understand and agree with the Membership provisions above.

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