Restaurant Member Registration – Arizona Restaurant Association

Business Name

Business Address

Street Address Address Line 2 City State ZIP Code

Contact Title

Phone

Email

Fax

Website

Additional Locations

Address	Phone	Email

Liquor License

Classification

Classification: Other

Structure

Structure: Other

Model

Model: Other

Number of employees (average per location)

Amount Due for Primary Location*

Price: $295.00 Quantity:

Please enter 0 if you are already registered for a primary location

Additional Locations

Price: $150.00 Quantity:

Number of member decals needed

Total

$0.00

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Billing Address

Street Address Address Line 2 City State / Province / Region Zip

Click here to fill out form and e-mail, mail or fax it to us!