Online Application

Please submit your annual dues in the amount of $350 via check directly to:

The SEFA
PO Box 473
Lake Zurich, IL 60047

Your application cannot be processed without submitting an online application (or sending us a PDF application) along with submitting payment via mail.

Any questions, please call (847) 370-9022.

Company Name

Address

Email

Website

Phone

Fax

Number of Years in Business

Territory Covered:

Main Contact (Designated Voting Representative)

Alternative Contact

Check One:
DistributorSupplierImporterMfg RepService Provider

Annual Dues: $350

SPONSOR REQUIREMENTS

One Distributor Member & One Supplier Member

Sponsor #1

Sponsor #2

Digital Signature

Date