AIWD Prospective Member Form

All information will be kept confidential by the AIWD Exec Dept.

Company name

Multi-line address

Country/Region

Address

City

Zip / Postal code

First name

Last name

Position

Email

Phone

Company URL

How did you hear about us?

Personal Referral Name

Personal Referral Company

"Other" description

Please answer "Yes" or "No" to the following questions:

Does your company sell welding supplies, welding machines, or related hard goods?

Yes

No

Do you repair Welding Equipment?

Yes

No

Do you have a CO2 Bev. Carb business?

Yes

No

Does your company sell safety supplies?

Yes

No

Does your company sell hand tools?

Yes

No

Does your company sell Industrial Gases?

Yes

No

Does your company sell Specialty Gases?

Yes

No

Who supplies your Gases?

Does your company fill specialty gas cylinders?

Yes

No

Does your company fill industrial gas cylinders?

Yes

No

Do you wish to become a member of AIWD?

Yes

No

Are you a member of a buying group?

Yes

No

If Yes, which one(s)?

Please answer the following questions:

Number of years your company has been in business:

Number of Employees:

What is your company's ownership structure?

Approximate Annual Revenue ($USD)

Percentage Sales: Gas and Rent %

Percentage Sales: Hard Goods %

Percentage Sales: Other %

Number of facilities: (Main Office + Branches)

Add your text

List cities and towns, if applicable:

Please check and/or add who your core suppliers are:

Lincoln

Miller

ESAB

Hypertherm

Hobart

Other Core Suppliers not listed:

Please describe the geography that your company serves (e.g., state(s), county(ies), radius around a city/town):

Please describe the benefits you seek from the AIWD:

Membership

Membership is open to welding supply and industrial gas distributors that meet the following criteria: Members shall not be companies that have stock or securities listed on a nationally recognized securities exchange or have stock or securities traded over-the-counter; Members shall not have gross annual revenue in excess of $250,000,000; Members shall not have gross annual revenue less than $500,000; Members shall have been in business for more than two consecutive years. Acceptance and membership is subject to AIWD By-Laws and Rules & Regulations.

By this form, I understand that the information provided here is for the sole purpose of applying for membership in the AIWD, Inc., and that it will be held in strict confidence. I believe this information to be accurate. I also understand and agree with the Membership provisions above.