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2008 PIWHA Membership Application
Company __________________________________________
Address __________________________________________
PO BOX __________________________________________
City, ST __________________________________________
Phone __________________________________________
FAX __________________________________________
E-Mail __________________________________________
Contact __________________________________________
Web Site__________________________________________
How Many Trucks ___________________________________
In What Counties Do you Service ________________________
What Type of services do you offer _______________________
Dues
1 to 3 Trucks $300.00
4 to 9 Trucks $500.00
10 or more Trucks $700.00
Associate Members $250.00
PLEASE MAKE ALL CHECKS PAYABLE TO PIWHA.
PIWHA
PO BOX 2609
IVYLAND PA 18974
ATTN. Jason Leck
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Installment plans are as follows
First payment due Jan 31st 2006
Number of Trucks
1-3 $165.00
4-9 $275.00
9-more $385.00
Second payment due March 31st 2006
Number of Trucks
1-3 $165.00
4-9 $275.00
9-more $385.00
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