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Business Name:

Type of Business

Owners Name:

List all owners, if corporation list all owners and principles

Contact / Representative

Business Address

Business Phone

Business Fax

Home Phone

Email Address

Web Address

List any political officials known

Areas in which you have interest to participate

	Lobbying		Logistics
	Fund Raising		Newsletter
	Public Relations		Web Site
	Legal		National Association

Each member must agree to uphold the CT Association of Pawnbrokers Code of Ethics. When submitting your application for membership via our online form, you must also send your $300.00 (1-5 employees) or $500.00 (5 or more employees) membership dues for the first year at the same time. You may mail your payment to us at the address below. Your application can not be processed until this has been received. If your application is denied you will be refunded these dues.

CT Association of Pawnbrokers Inc

503 Lakewood Road

Waterbury, CT 06704

Once you have submitted your application and payment has been received you will be contacted by a member of the Board of Directors to schedule a meeting at your business location.