|Please answer the following questions:
|How long has your company been in business? Years
||Number of employees:
|What is your company’s ownership structure?
|Approximate annual revenue $
||% Sales mix: Gas & Rent: %
|Number of facilities (Main office, branches):
||Please list the cities/towns:
|Please check and/or add who your core vendors are:
|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 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.