Membership Form | Indiana Towing & Wrecker Association, Inc.

Prefer to send a check? Make checks payable to ITWA. Download the application here and return to:
PO BOX 395,
Dayton, IN 47941

Date*

Referred by:

Membership Type*

Regular Membership - $365
500 Club Membership - $500
Employee Membership - $50
Supporting Membership - $100
Associate Membership - $365
Bronze Membership - $1000
Silver Membership - $1500
Gold Membership - $2500

Company Name*

Company Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Fax

Email*

Name of Owner*

First Last

Years in business*

# of employees*

# of wreckers*

Other associations your company belongs to*

If you checked Associate Member, what products do you sell?

Add additional employees?*

$50 for each additional employee

Employee name*

First Last

Email*

Employee name*

First Last

Email*

Employee name*

First Last

Email*

The undersigned is requesting acceptance into the membership of the Indiana Towing & Wrecker Association and promises to abide by the By-Laws of the Association. Unless otherwise noted the member’s information will be listed on the ITWA website and in the membership directory. The following signature also gives ITWA permission to charge your credit card for dues.

Signature

Title

Date

Processing Fee

Price: $0.00

Total

$0.00

Membership Application Form