Membership Application
The Surplus Exchange
MEMBERSHIP APPLICATION
Organization ___________________________
Phone __________________ Fax __________________
Address _______________________________
City__________ State _____ Zip_________
Authorized Official _______________________________
Title ________________ Alt phone# _________________
Email _______________
Other Representative _____________________________
Alt phone# ___________________ Email _______________________
Other Representative _____________________________
Alt phone# ___________________ Email _______________________
Membership with The Surplus Exchange is designated for Non-profit Organizations which are exempt
from Federal Income Tax. Current proof of Non-profit status (501(c)3) must be on file at all times with
The Surplus Exchange.
Lifetime membership with The Surplus Exchange is Fifty Dollars per organization, payable with this
application. Although we will not require additional fees to maintain your membership, we do ask for
occasional updated documentation of your Nonprofit status.
In order to serve your organization best, we also ask that you send us a brief summary, or Mission
Statement, describing your organization.
I, the undersigned, have read and understand the above, and affirm that my organization meets the
membership criteria.
Signature____________________________Date____________