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Select One:

____ YES, I'd like to be a Level 1 Dealer Member of WHACO!

My $30 annual dues is enclosed.
Dealer membership includes: ____YES, I'd like to be a Level 2 Dealer Member of WHACO! with the benefits above
and a copy of the current WHACO! Database CD on Disk.

My total cost of $60 is enclosed. It includes:

____YES, I'd like to be a Level 3 Dealer Member of WHACO! with the benefits above
and a year's subscription WHACO! Database CD on Disk.

My total cost of $90 is enclosed. It includes:

DEALER MEMBER INFORMATION

PRINT NAME

______________________________________________________

DEALERSHIP NAME (If different)

______________________________________________________

MAILING ADDRESS

______________________________________________________

CITY__________________________________

STATE___________ZIP CODE____________

PHONE:_____________________FAX:_____________________

E-mail ADDRESS

______________________________________________________

HOMEPAGE URL

______________________________________________________

SPECIALIZING IN

______________________________________________________



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