* Sams' Club purchases do not qualify.
Do you belong to another Buying Group?*
Are you affiliated with a Franchise?*
ACH for Rebate Deposits
I agree and certify that I am the legal owner or authorized signer for this business and that all the
information provided is true and accurate. I am legally capable of entering into this agreement and
I agree to all terms and conditions as a Retailer Member of the Convenience Marketers Association. I
certify all orders, reports and data including but not limited to records of sales or purchases,
which I or my representatives will provide to CMA, to be true and accurate to the best of my
knowledge. I authorize CMA to utilize said data for the sole purposes of negotiating and redeeming
on my behalf, any and all CMA programs and promotions for each location I enroll. While enrolled
with CMA, I authorize CMA to administer the tracking and payment for all CMA manufacturer programs
in excess of my supplier and distributor programs. I acknowledge that any/all user permissions for
programs, technology, process, or information at www.getcma.com are proprietary and provided to me
and my authorized representatives on a confidential basis, solely for internal use. As such, I
certify that I and my representatives will not replicate, disseminate, share, or transmit in any
form, without prior written consent by Convenience Marketers Association.
here to indicate that you have read and agree to the CMA Terms & Conditions
Signature of Applicant
Please return completed form to Psiegal@getcma.com
or fax to 224-222-1025. Any questions please contact Pam Siegal at PH: 224-425-4448
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