Allied Supplier Membership Application

4181 W.2100S., West Valley, UT 84120

(801) 973 – 9370

jon@utahtrucking.com

Date

Company Name

DBA (If Applicable)

Key Contact Name

Title

Physical Address

Mailing Address

Phone

Sales / Marketing Manager Name

Accounts Payable Contact

Annual Dues Investment Schedule

Allied Member Dues (50 or Less Utha Employees): $415 Allied Member Dues (51 or More Utha Employees): $525 Out of State Company Dues: $415

Authorized By

Title

Signature

Date

**Upon signing this application, this gives Utha Trucking Association the expressed permission to fax and/or email information to key contacts in your company, as per the Telephone Consumer Protection Act**

*Subject to review and approval by UTA Board of Directors.