Corporate Membership Applications
Click HERE to download a PDF of our membership application. Please email completed forms to pdetrade@comcast.net.
Corporate Membership Application
The following information is required to have the PDE Board of
Directors consider your application for membership in the PDE.
Directors consider your application for membership in the PDE.
Company Name:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Website:
Nature of Business:
Pharmaceutical Manufacturer Chemical Supplier Allied Trade (Specify)
Type of Organization:
Corporation Private Publicly Held Division
Name of Parent Company:
Individual
Name of Parent Company:
Individual
Annual sales:
Annual sales to the drug industry:
Number of drug industry customers:
Number of employees:
Date Founded:
Company Information
Describe key product line(s) or service(s) provided:
Interest in the PDE
Please state why your company is interested in joining the PDE:
Company Representatives
Please give the following information for the persons who would represent your company with the PDE as:
Official Correspondent: (Primary contact)
Name:
Title:
Preferred Mail Address:
City:
State:
Zip Code:
Office Phone:
Cell Phone:
E-Mail Address: