Membership Application Annual Invoice

Company Information
Company Name
Physical Address
City
State
Zip
Work Phone
Website
PO Box/Mailing Address (if different)
PO Box/Mailing Address
City
State
Zip
Primary Contact Information
This individual will be the primary contact for all Natural Stone Institute business matters including: having the company’s vote on any membership issues submitted for a vote; receiving all member mailings and communications and acknowledges understanding of the Privacy Policy; and agrees that the company will adhere to the Code of Ethics.
First Name
Last Name
Title
Email
Direct Dial
Mobile
	May we text you? choose oneYesNo
Business Information
This information will be used for your membership directory listing.
Choose primary	choose oneAffiliateAllied AssociationDistributor: Equipment/ToolsInternational QuarryEndorsed Partner ProgramEngineered Quartz ProducerFreight ForwardingManufacturer: Equipment/ToolsNorth American QuarryProduct Sales RepresentativeStone ConsultantStone DistributorStone ExporterStone FabricatorStone ImporterStone InstallerStone ProcessorStone Producer/QuarrierStone Restoration/MaintenanceSupplier to Industry - OtherWholesale Slab Distributor
The following information is kept confidential.
Number of Employees
Approximate Annual Sales (in US dollars)	choose oneUnder $1 million$1 - $5 million$5 - $10 million$10 - $25 millionOver $25 million
Membership Dues
DUES AMOUNT	choose oneAnnual Invoice (invoice will be sent for payment): $1000Annual Auto Withdrawal Payment: $1000Semi-Annual Auto Withdrawal Payment: $500Quarterly Auto Withdrawal Payment: $250
You will be prompted for Payment Method on the following screen after verifying your information.
Additional Locations
Do you have branch locations that require directory listing and member services? choose oneNONE1 @ $2002 @ $4003 @ $6004 @ $8005 @ $10006 @ $12007 @ $14008 @ $16009 @ $180010 @ $2000
You will be contacted for additional information on the branch locations.

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By submitting this form, I agree to receive marketing communications from the Natural Stone Institute and its partners. I understand that I can unsubscribe from communications at any time and that details are outlined in NSI’s Privacy Policy.