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Columbia Sales Exchange
Membership Application

 

Applicant's Name:

Business Phone:

Company:

Cell Phone:
Address: FAX:
Address: Email:
Nature of Business: Website:
Years in Industry: Other:
Referring Member: RM Email:
 

Describe exactly what products and services you sell:

    
 
List two business reference, contact person, and telephone number:
    
 
List any organizations to which you are a member:
    
 

I authorize investigation of all statements contained in this application.  And I understand that any misrepresentation or omission of facts called for is just cause for non-approval or dismissal by the Columbia Sales Exchange.  I do not belong to, attend, or participate in any way in another leads group or tips club.  I understand that this application must be approved by the membership as well as the Board of Directors and my dues and application fee be paid before I am officially a member.  All dues are non-refundable.  By signing this application, I agree to abide by the rules and by-laws of the Columbia Sales Exchange and not hold the exchange or any of its' members liable in any way.

 

Applicant:
Date: