Supplier/Professional Membership Application


Pennsylvania Cemetery, Cremation & Funeral Association
2200 Northampton Street, Easton, PA 18040
Phone: (610) 253-5222  --  Fax: (610) 253-3636  --  Email: DCM.Colleen@gmail.com

Supplier/Professional Membership Application

SECTION A: COMPANY INFORMATION

Company Name:  

Address:

Mailing Address (If different from above):

Representative:  

Title:  

Business Phone:           Fax:  

Email:            Cell Phone:  

Products or services you offer as a Supplier:

SECTION B: INFORMATION

Total number of people on payroll:  (Full Time), (Part Time)

Total number of years you have been in business:  

Geographical area you serve:  

I/ we hereby apply for admission as members of the Pennsylvania Cemetery Cremation and Funeral Association. Membership dues are as published and may change with action approved by the board of directors with due notice to members. If this application is approved, I/we agree to be governed by the bylaws of the organization as they are now or may be hereafter amended. I/We acknowledge that by including our e-mail address, PCCFA is granted the right to send you association information, which may include supplier member’s information, in an electronic form. You will have the right to notify us to opt out of information from supplier members.

Leave this empty:

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Signature Certificate
Document name: Supplier/Professional Membership Application
lock iconUnique Document ID: 1ab77b00d6aaef7d65640185127a5ececb3ebbb3
Timestamp Audit
October 13, 2022 12:48 pm ESTSupplier/Professional Membership Application Uploaded by PCCFA Online - megan.warner@webcemeteries.com IP 73.214.215.96
November 2, 2022 1:22 pm ESTPCCFA Exec Team - PCCFA.exec.team@gmail.com added by PCCFA Online - megan.warner@webcemeteries.com as a CC'd Recipient Ip: 73.214.215.96
November 2, 2022 1:22 pm ESTDagny Neel Fitzpatrick - dagny@jeffersonmemorial.biz added by PCCFA Online - megan.warner@webcemeteries.com as a CC'd Recipient Ip: 73.214.215.96
November 2, 2022 1:22 pm ESTCharles Schwalm - cschwalm@letuminc.com added by PCCFA Online - megan.warner@webcemeteries.com as a CC'd Recipient Ip: 73.214.215.96
November 2, 2022 1:22 pm ESTErnie Petersen - southsidestray@mac.com added by PCCFA Online - megan.warner@webcemeteries.com as a CC'd Recipient Ip: 73.214.215.96
November 2, 2022 1:22 pm ESTMegan Warner - megan.warner@webcemeteries.com added by PCCFA Online - megan.warner@webcemeteries.com as a CC'd Recipient Ip: 73.214.215.96