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MFDA Membership Application

  • Supplier#of Check Out LanesAnnual Non-Gas Sales VolumeSquare FeetNumber of EmployeesNumber of Pumps 
    Complete for each of your store's locations
    Note:
    -Workers Comp insurance is required by law.
    -Group Health Insurance is for groups of 50 or more.
    -No Minimum coupon count or value.
  • By typing your name here, you are signifying that all of the information given above is accurate and complete to the best of your knowledge, and you are aware that the information given above will remain confidential, and used only to improve and expedite member services.

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