Membership Application
Become a Member Today!
To join the CCA complete the following and mail or fax it today.
Mail to: CCA, PO Box 230, Rexford, NY 12148
Fax to: 518*877*6779

Please indicate the type of membership for which you qualify
by writing in the number of memberships you would like to purchase:

Carwash	at $250.00
Manufacturer/Distributor	at $300.00
Additional Locations* (associate membership)	at $25 each

*Associate membership is available to additional carwash locations only.
Annual dues are $25 for each additional location.
Associate memberships are available only after a Primary Membership has been paid and includes CCA window sticker, mailing list, NE Carwasher and all membership mailings.

CARWASH NAME

First Name:

Last Name:

E-mail Address:

Phone Number:

Mailing Address:

City

State

zip

TYPE OF LOCATION (CHECK ALL THAT APPLY)

NUMBER OF LOCATIONS

total payment

credit card (secured server)

cc#

expiration