1 COMPANY NAME: NAME OF REPRESENTATIVE: TITLE: YEARS IN BUSINESS: MAILING ADDRESS: CITY: STATE: ZIP: BILLING ADDRESS: CELL: OFFICE PHONE 1: EMAIL WEBSITE: 1 Company Name: Contact: Address: Phone: Fax: 1 Company Name_2: Contact_2: Address_2: City State Zip: Phone_2: Fax_2: Home Address: City State Zip_2: Home Phone: Date of birth: Number of Employees: Sales Volume: Homes Built in the Past 12 months: undefined_2: undefined_3: Date: CARD NUMBER: NAME ON CARD: CSV: EXP: EMAIL RECEIPT TO: CARD BILLING ZIP CODE: This Membership Dues Payment Agreement the Agreement is entered into as of the: day of: with: the Member both of whom agree to be bound by this Agreement Whereas the Member owers the Association: I am financially responsible for payments per this agreement: My company is financially responsible for payments per this agreement: DATE: 2: Off1: Off3: Off4: OffText9: Text10: Text11: 13: Off14: Off15: Off16: Off17: Off27: Off28: Off29: Off30: Off31: Off32: Off33: Off34: Off51: Off52: Off53: Off54: Off55: Off56: Off57: Off58: Off59: Off60: Off61: Off62: Off50: Off75: Off76: Off77: Off78: Off79: Off80: Off81: Off82: Off83: Off84: Off85: Off86: Off87: Off26: OffText14: 11-1: Off11-2: Off11-3: Off11-4: Off11-5: Off11-6: Off11-8: Off11-9: Off11-10: Off11-11: Off11-7: Off11-12: Off11-13: Off11-14: Off11-15: Off11-16: Offcc: Offcash: OffGreater Kansas City the Association and: