ACBC Membership Application

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AMERICAN CONTRACTOR’S BUYING CO-OP

Application for Membership

Member’s name: _______________________________________________________

USAID Contractor (Your) name

Home Address: ________________________________________________________

Home Phone: __________________________________________________________

Work Phone(s): ________________________________________________________

Mobile: _______________________________________________________________

Fax number: ___________________________________________________________

E-mail home: ___________________________________________________________

work:___________________________________________________________

Company name: ________________________________________

Company address: ______________________________________

_________________________________________________

Company phone: ________________________________________

USAID Project name: ____________________________________

Proof of Eligibility:___ Letter from Chief of Party __US Passport

___Letter from USAID Contract Office (3rd Country Nationals)

Date your contract ends: ___/___/___

I request membership in the American Contractor’s Buying Co-op.
I have read the requirements for participation and agree to furnish all necessary documentation as outlined in "Joining ACBC"
I understand that membership in American Contractor’s Buying Co-op terminates when my USAID contract ends or December 31, 2005, whichever is first.
I agree not to sell, lend or give any items purchased or imported through ACBC to nonmembers. I understand that failure to adhere to this policy will result in immediate termination of membership.
I have read and agree to follow the guidelines for ordering commodities detailed in "Ordering from ACBC".
I understand that the American Contractor's Buying Co-op is a voluntary cooperative organization managed by a volunteer Coordinator. While the American Contractor's Buying Co-op will obtain insurance to limit major losses throughout the process, the organization, including its membership, will not be responsible for losses.

Signature:_______________________________________________(Contractor or spouse)

Date:____________________________________________________

Registration Fee paid (date):_______________________________