PSA Membership Application Form


Annual Fees:
Includes quarterly PSA News, monthly update, plus all benefits offered by PSA .......................... $200.00

Membership Classifications:

  • SC = Service Company
  • EDU = Educational
  • PD = Parts Distributor
  • MFG = Manufacturer
  • TPA = Third Party Administrator
  • IRV = Industry Related Vendor
  • AM = An Associate Member can be Unclassified Service Companies or any individual that is interested in the welfare of the service industry.
  • Your First Name:
    Your Last Name:
    Position:
    Company:
    Address1:
    Address2:
    City, State & Zip:
    Phone:
    Fax:
    Email:
    Membership Classification:

    (see above)

    Coupon/Discount:

    Please put me on PSANet email list (our industry discussion forum).

    Please subscribe me to PSANews


    Charge to: Visa  MasterCard  Discover  American Express 

    Name On Card: *  

    Card Number: *   Exp Month: *   / Year: *  

    Verification Code: *  


    Thank you for completing our membership form!