Membership Application

The Surplus Exchange


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.