Name of Company Applying for NIBA Membership: *

NIBA Membership Application Category Being Applied For: *

Enter required value Distributor/Fabricator Belting Manufacturer Component Manufacturer Affiliate

Name of Contact Person From the Company Applying for NIBA Membership: *

Email of Contact Person from the Company Applying for NIBA Membership:

Reference Contact Name *

Reference Contact Company *

Reference Email *

Reference Phone *

Is your company a NIBA member? *

Enter required value Yes No

How are you associated with this applicant company? *

Vendor

Supplier

Customer

Other (specify in comments)

How long have you been associated with this company? *

> 1 year

2 - 5 years

5 - 10 years

More than 10 years

If the applicant is a manufacturer, have you physically visited the manufacturing site? *

Yes

No

Not applicable

If the applicant is a manufacturer, do they sell primarily to: *

Enter required value Distributors End Users Not applicable

If the applicant is a distributor, can you confirm if they have any of the following equipment? *

Mechanical Slitter

Lacing Equipment

High Frequency Presses

Vulcanizer (Heavy Weight & Light Weight)

Cleating/V-guide Machinery

Other (specify in comments)

Not applicable

If the applicant is a distributor, what type of belts are sold? *

Lightweight belting

Heavyweight belting

Modular

Metal

Other (list in comments)

Not applicable

If the applicant is an affiliate, does their product enhance the industry? *

Enter required value Yes No Not applicable

How does the applicant provide value to the belting industry? *

Comments *