MEMBERSHIP APPLICATION FORM
American Online Users will not be able to send applications.  
Please call Mary Stanyk for any questions at 866-FOR-MPTA ext. 105


Company Name:
E-Mail:
Address1:
Address2:
City: , State:
Postal Code:
Telephone:
Facsimile:

Membership 
Type: 		General - Payphone Service Providers $250.00
     Payphone providers $1.50 per phone per month, 
      plus .50¢  per month early pay discount.
Supplier - $500 per year
OSP - $750 per year
Payphone Manufacturer - $750 per year 
(suppliers and manufacturers can provide equipment for 
auction in lieu of dues)

Industry suppliers, please provide description of your business:


# of payphones your company currently operates in Michigan:


Does your business exist in states other than Michigan?


How many years have you been in the payphone business?


Are you affiliated with any other payphone associations? (Please Specify)


Would your company be willing to contribute its expertise? If so, in what areas?


*
 
Michigan Pay Telephone Association is a registered trademark.
© 1998 Netrus