| VIRGINIA MOTORCOACH ASSOCIATION 106 Main St., Brookneal, VA 24528 434-376-1150 FAX 434-376-1156 MEMBERSHIP CONTACT INFORMATION UPDATE FORM Company Name: ____________________________________________ Address: ___________________________________________________ City: ______________________ State: _________ Zip: _____________ Phone: ______________ #800: _______________ FAX: _____________ Email: ______________________________________________________ Web: _______________________________________________________ Contact:_____________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Delete the Following Contacts: ___________________________________ ___________________________________________________________ Misc. Information:_____________________________________________ ___________________________________________________________ Operators ONLY: Number of Coaches: ________________ Classification Code: ________________ Periodic Mailings to (number) ________________ customers. Other Changes: ________________________________________________ _____________________________________________________________ _____________________________________________________________
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