Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.NEGDA Dealer Member Application Use the form below to fill out the application online OR download the application here. Company NamePrimary Contact *FirstLastPrimary Contact TitlePrimary Cell Phone #Primary Office Phone #Primary Email: *Mailing AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhysical Address (if different from Mailing)Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHow many years have you been in business as a full-service generator dealer?Which markets do you serve (check all that apply)?ResidentialCommercialIndustrialDoes your company provide 24/7 generator service?YesNoIs your revenue solely based upon generator related sales and service?YesNoWhat percentage of your business revenue is generator sales and service?Which generator brands do you representGeneracKohlerBriggs & StrattonCummins/OnanOtherHow many factory authorized technicians do you employ?What is your total generator related revenue including new equipment sales, installation, and service combined for last year?less than $500K$501-$999K$1M - $2.9M$3M - $4.9M$5M - $8.9M$9M+What other professional/trade associations do you belong to?How many generators are in your rental fleet?How would describe the territory your company covers? Please include all states and/or regions you do business in:How do you feel you could enhance the mission of NEGDA?What do you hope to gain through NEGDA membership?Submit