30 West Lafayette Street

Trenton, NJ 08608
609-392-8899
609-396-6571 Fax
www.njfoodcouncil.com

2016 APPLICATION FOR RETAIL MEMBERSHIP

Please enroll my firm as a Member of the New Jersey Food Council. My firm is engaged primarily in
food retailing in the State of New Jersey. Total sales volume of all NJ food retailing outlets of this firm
for the preceding calendar year ending December 31st was ______________. Based upon this sales
volume, the current annual dues for my firm are $_______________.
Check enclosed: _______

Please send invoice: _________ Credit card charge: __________

MC___VISA___AMEX____Card#_________________________Exp:__/__
____________________________

Signature:

Please print or type.

FIRM NAME: __________________________________________________________________________________________
ADDRESS:

__________________________________________________________________________________________

CITY/ST/ZIP: __________________________________________________________________________________________
CONTACT(S): _____________________________________________ ___________________________________________
(Up to 3)
Name
Title
_____________________________________________ ___________________________________________
Name
Title
_____________________________________________ ___________________________________________
Name
Title
PHONE/FAX: _____________________________________ ___________________________________________________
Phone
Fax
E-MAIL

___________________________E-MAIL______________________E-MAIL___________________________
#NJ EMPLOYEES: _______ #NJ STORES: _______
DUES SCHEDULE
SALES VOLUME
0-5 Million
5-10 Million
10-25 Million
25-50 Million
50-100 Million
100-150 Million
150-250 Million
250-500 Million
Over 500 Million

DUES
$238
$784
$1,105
$2,881
$5,470
$8,278
$11,036
$13,800
$17,476

DUES CHECKS SHOULD BE MADE PAYABLE TO THE NEW JERSEY FOOD COUNCIL.
Contributions or gifts to NJFC are not deductible as charitable contributions for Federal Income Tax
purposes. However, they may be tax deductible as ordinary and necessary business expenses subject to

restrictions imposed as a result of association lobbying activities. NJFC estimates that the nondeductible
portion of your Dues-the portion which is allocable to lobbying- is 15%. EIN: 22-1863080
Thank you for your support.