Application for Voting Membership

1. Company Name
_______________________________________________________________________________


2. Street Address
_______________________________________________________________________________

3. City, State, Zip Code
_______________________________________________________________________________

4. Telephone Number____________________________ Fax Number ______________________


5. Primary Representative ______________________________________ Title _______________

(designated as applicant's representative to receive mailings and participate in IFRA activities)


6. Type of Business: []Corporation...... []Partnership.......[]Proprietorship


7. Names of Principals:

A. __________________________________________________ Amount of ownership______%

B. __________________________________________________ Amount of ownership______%

C. __________________________________________________ Amount of ownership______%


8. How long in the furniture rental/leasing business
_______________________________________________________________________________

9.
A. _________ % of total revenue from furniture rental, leasing and sales.

B. _________ % of total revenue from appliance rental, leasing and sales.

C. _________ % of total revenue from other sources. Explain: ___________________________________


10.
A. _________ Current number of apartment furniture rental agreements.

B. _________ Current number of appliance and/or television rental agreements.

C. _________ Current number of office furniture rental agreements.

D. _________ Current number of other types of rental agreements. Explain: ________________________


11. Nature of business applicant engaged in before entering into furniture rental business:
_______________________________________________________________________________

12. Square footage area devoted exclusively to furniture rental/leasing:

Warehouse only ___________ Showroom only ___________ Total ___________


13. How many showroom locations does applicant have: ___________


14. Are you in the yellow pages? ___________ What directories? ___________


15.
Percent of units rented/leased presently to individuals ___________

Percent of units rented/leased presently to apartment owners ___________

Percent of units rented/leased to offices ___________


16. Population of area you serve (approximate) __________________ Radius in miles _________


17. With whom do you bank:

Bank Name _________________________________ Branch _____________________________

Branch Address
_______________________________________________________________________________

Branch Contact _____________________________ Branch phone number __________________


18. Rated in Lyons ____________________ and/or Dunn and Bradstreet ____________________


19. Please list three or more business references, including at least two past or present suppliers:

List Company Name, Address, Products Purchased

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

20. Have you ever been found to have engaged in practices in violation of the law by the Federal Trade Commission, state or local law enforcement authorities? _________
If answer is yes, please attach copies of all orders issued against you by the FTC, state or local agency involved.


21. Have you ever entered into consent or other formal voluntary agreements covering your business practices with the FTC, state or local authorities? _________


22. Please attach copies of your standard lease or rental agreement, yellow pages advertisements, promotional materials, and other advertising currently in use by your company.


I hereby agree to a personal visit by a member of the IFRA for the purpose of reviewing my application and reporting thereon to the IFRA membership committee.

Authorized Signature__________________________________________________

Title________________________________________________________________

Date________________________________________________________________