MANUFACTURER AND MANUFACTURER
REPRESENTATIVE MEMBERSHIP APPLICATION
Company Name ____________________________________________________________________________
Name of Primary Contact______________________________ E-mail ________________________________
Title _____________________________________________________________________________________
Note: The Primary Contact is the person who will be the recipient of information from ISSA.
Name of Official Representative________________________________________________________________
E-mail _____________________________________________________________________________________
Title: Check one. Must be:
Owner or Partner
CEO/COO or President
General Manager
Vice President/Officer
Most Senior Manager for Jansan Industry
Note: The only purposes of the Official Representative are to vote and hold office. No other mailings will
go to the Official Representative.
Mailing Address ____________________________________ City ___________________________________
State/Province _________________ Postal Code ___________________Country ______________________
Shipping Address __________________________________ City ___________________________________
State/Province _________________ Postal Code ___________________Country ______________________
Phone ________________________ Toll-Free _____________________ URL/Web Site ________________
Company E-mail* _________________________________________ Company Fax* ____________________
*E-mail and fax will be used in the ISSA Membership Directory.
Applicant referred by: Name __________________________Company ______________________________
CONTACTS
List key employees to receive access to the online Members’ Lounge.*
(*Members’ Lounge is an area exclusive to ISSA members to research, network, and educate themselves on the cleaning industry.)
Trade Show Contact ______________________________________ E-mail ___________________________
Title ____________________________________________________________________________________
Education/Training Contact ________________________________ E-mail ___________________________
Title ____________________________________________________________________________________
Legislative/Regulatory Contact _____________________________ E-mail ___________________________
Title ____________________________________________________________________________________
Young Executive Society (YES) Contact ____________________ E-mail __________________________
Title _____________________________________________________________________________________
Standards/Certification Contact _____________________________ E-mail ___________________________
Title ____________________________________________________________________________________
Why did you join ISSA?____________________How did you hear about us?__________________________
_________________________________________________________________________________________
What do you want to receive as a result of your membership? _____________________________________
_________________________________________________________________________________________
I consent to receive all unsolicited communications sent by or on behalf of ISSA, the ISSA Foundation, and all ISSA affinity program providers.
CODE OF ETHICS ACKNOWLEDGEMENT: The Applicant hereby certifies that it has reviewed ISSA’s Code of Ethics and all applicable agreements online
at www.issa.com/code and is in compliance therewith. The Applicant further agrees that it will remain in compliance as a condition for continued ISSA
membership. All statements made by me and contained herein are true.
Signature Required ________________________________________ Date ____________________________
ISSA • 3300 Dundee Road, Northbrook, IL 60062-2303 USA
800-225-4772 (U.S./Canada) or 847-982-0800 • Fax: 847-982-1012 • info@issa.com • www.issa.com
BUSINESS REFERENCES: (Two business references are required. Please include company name, address, phone, and contact person.)
1.
2.
MEMBERSHIP CLASSIFICATIONS (Check one only.)
Manufacturer
membership shall be open to those firms engaged in the manufacture of products for sale to members. This
classification is also open to importers into North America from one or more international manufacturers for sale to members.
Manufacturer
representative membership shall be open to those firms that are independent contractor sales representatives
of ISSA manufacturer members.
PRODUCT DESCRIPTIONS
(Please provide the following information that may be used for the ISSA Membership Directory. ISSA reserves the right to edit descriptions for publication purposes.)
Describe the products and services you offer or publication title and purpose.
BRAND NAMES
Please include your company’s brand names and a general description of the type of product for each brand name (5 words or
less). If you have several to include you may attach a separate typewritten page. (ISSA reserves the right to edit descriptions for publication purposes.)
Brand Name:
Brand Name Description:
Indicate which segment most closely describes your primary business: (Check one only.)
Janitorial supply
Food/food services
Hardware
Industrial supplies
Office supplies
Medical supplies
Safety equipment
Other (Describe)
Paper
ISSA BRANCHES
Keep your key employees current on issues impacting our industry! Branch memberships put information into the hands of your
team when they need it. Sign up below for branch memberships. Purchased branches are available at the indicated rate.
Name
Title
Company
Address
Phone
Fax
Name
E-mail
Title
Company
Address
Phone
Fax
E-mail
Photocopy for additional branches and affiliate subscriptions.
By providing fax numbers and e-mail address(es) we consent to receive all fax and e-mail communications sent by or on behalf of ISSA, the ISSA Foundation, and all ISSA partner affinity program providers.
ISSA MEMBER PRODUCT/SERVICE CODES
Please place a check mark ( ) next to the product or service (code) your company provides. Limit of 20 listings.
Abrasives
Absorbents – Oil, Grease & Water
Acoustical Cleaning Chemicals & Equipment
Adhesives
Aerosols
Air Filtration Equipment
Anti-Graffiti Systems
Anti-Static Chemicals
Ash Trays
Associations/Societies
Automatic Scrubbers
Automotive Cleaning Specialties
Baby Changing Stations
Bacterial/Enzyme Products
Bag-in-the-Box Packaging
Bar Code/EDI Technology
Baseboard Cleaning Machines & Accessories
Batteries & Chargers
Bedding Supplies
Bird & Animal Control Products
Blowers
Brooms
Brushes
Buckets
Burnishing Equipment
Buying Groups
Candles
Carpet & Fabric Protective Finishes
Carpet Cleaning Chemicals – Brand Name
C
arpet Cleaning Chemicals – Private Label
Carpet Cleaning Wands & Accessories
Carpet Drying Equipment
Carpet Dyeing Systems
Carpet Extractors
Carpet Shampoo Machines & Accessories
Carpet Spotting Kits
Carpet Sweepers – Electric
Carpet Sweepers – Hand
Carts – Hospital, Janitorial & Maid
Carts – Trash
Catalog Publishers
Chalkboard/Blackboard Cleaners
Chemical Dispensing Systems
Chemicals – Raw Material
Cleaners – Chemical Free
Cleaning Chemicals – Brand Name
Cleaning Chemicals – Private Label
Cleaning Services
Cloths – Microfiber
Cloths – Non Woven Disposables
Colorants & Dyes
Computer Systems & Software
Concrete Floor Treatments
Consultants – Advertising
Consultants – Financial
Consultants – Marketing
Contamination Control Products
Degreasers
Dehumidifying Equipment
Deodorants
Disinfectants/Sanitizers – Brand Name
Disinfectants/Sanitizers – Private Label
Disinfectants/Sanitizers – Raw Material
Dispensers – Paper Products/Soaps
Drain Opener Chemicals
Drain Opener Equipment
Drums
Dust Pans
Dusters
Dusting Cloths
Electric Cord Reels
Electric Motors
Electrical Testing Devices
Emergency Response/Regulatory Services
Equipment Repair
Escalator Cleaning Machines
Feminine Care Products
Filters
Financial Services
Fire Extinguishers
Fire Restoration Products
Floor Finish Applicators
Floor Finishes – Brand Name
Floor Finishes – Private Label
Floor Machine Brushes
Floor Machine Motors
Floor Machines
Floor Pad Holders
Floor Pads
Floor Pads – Raw Material
Floor Sealers – Brand Name
Floor Sealers – Private Label
Food Processing Products
Food Service Disposable Tableware
Food Service Equipment & Supplies
Fragrances
Gloves
Gum Remover
Hand Dryers
Hand Sanitizers
Handles – Mop, Broom, Brush & Telescopic
Hoses – All Types
Human Resources
Ice & Snow Removal Compounds
Indoor Dust Control Equipment
Insect & Rodent Control Chemicals & Devices
Installation Services
Insurance Services
Labeling
Ladders
Laundry Chemicals
Laundry Equipment
Lawn & Turf Chemicals
Lawn & Turf Equipment
Leasing – Equipment
Light Bulbs
Liquid Filling Equipment
Litter Vacuums
Lockers/Storage
Lodging Amenities
Lubricants & Oils
Magazine Publishers
Magnetic Attachment for Vacuums
Material Handling Equipment
Mats & Matting
Mats – Commode/Urinal
Microfiber Products
Mobile Cleaning Unit
Mop Treatment Chemicals
Mopping Equipment
Mops – Dust
Mops – Wet
Odor Control Chemicals
Odor Control Devices
Packaging Equipment
Packaging Supplies
Paint & Paint Products
Paper and/or Food Service Products
Paper Products – Office Supplies
Paper Products – Towel & Tissue
Pavement Patching
Personnel Services
Plastic Bags
Plastic Containers
Polishes – Furniture
Polishes – Metal
Polishes – Plastic
Poly Trash Can Liners
Pool & Spa Chemicals & Equipment
Pre-Measured Chemicals
Pressure Washer Pumps
Pressure Washing Chemicals
Pressure Washing Equipment
Promotional Products
Pumps & Dispensers
Purchasing & Marketing Services
Recycling Systems
R
epair Parts – Floor Equipment &
Vacuum Cleaners
Restaurant Supplies
Restroom Cleaning Machines
Restroom Equipment
Robotic Cleaning Equipment
Roof Maintenance Materials
Safety Apparel
Safety Products, Equipment & Signs
Safety Treads
Sales Incentives
Sanitizers
Scouring Chemicals & Powders
Scouring Pads/Bars
Scrapers
Shampoo Tanks
Smoking Urns
Soaps
Software
Sponges & Chamois
Spray Tanks
Sprayers & Foggers
Squeegees – Floor
Squeegees – Window
Steam Cleaning Chemicals
Steam Cleaning Equipment
Stone Restoration Systems
Striping Machines – Pavement
Surfactants
S
weepers – Electric, Gasoline & Propane
Sweeping Compounds
Technology Services
Telecommunication Services
Toilet Seat Covers & Dispensers
Toilet/Shower Compartments
T
raining Consultants, Materials & Programs
Uniforms/Apparel
U
pholstery Shampoo Machines & Accessories
Vacuum Cleaner Attachments
Vacuum Cleaner Motors
Vacuum Cleaners
Vacuum Tanks
V
enetian Blind Cleaning Equipment & Chemicals
Wall Washing Equipment
Warewashing Chemicals
Warewashing Equipment
Washroom Accessories
Waste Receptacles
Water Brooms
Water Treatment Chemicals & Devices
Window Cleaning Accessories
Wipes
Wood Treatment – Scratch Remover
Wringers
MEMBERSHIP DUES RATE SCHEDULE (Check one only.)
M
anufacturer /
Manufacturing Process
Indicate/remit per your sales volume.
Under $10 million $790
$10 – $20 million $1,040
$20 – $50 million $1,180
Manufacturer Representative
Complimentary Branches
You Are Entitled To:
1
2
3
6
12
24
$605
PAYMENT OF DUES
A remittance of one (1) full year’s dues is to accompany application. Dues are billed annually in December.
Second year dues will be reduced pro rata (in direct proportion to the month in which you joined).
Upon application approval, dues are non-refundable.
Special Note: Internal Revenue codes require that a not-for-profit trade association notify members that contributions
or gifts to ISSA are not tax deductible as charitable contributions. However, they may be tax deductible as ordinary and
necessary business expenses. This statement does not apply regarding contributions to the ISSA Foundation.
NEW MEMBER DUES (See rate schedule.)
Dues
$
Foundation
$
Form of Payment:
Check enclosed – Remit in U.S. funds
VISA (16 digits)
Charge my credit card account:
MasterCard (13 or 16 digits)
American Express (15 digits)
(Voluntary contribution suggested $70)
Total Amount $
Card Number
Month
Year
Expiration Date
Print Cardholder’s Name:
FOR ISSA USE ONLY: PAID $
Signature:
DATE
RVD
ACK
ISSA • 3300 Dundee Road, Northbrook, IL 60062-2303 USA
800-225-4772 (U.S./Canada) or 847-982-0800 • Fax: 847-982-1012 • info@issa.com • www.issa.com
Man.
2015