Payments to AHAA are not tax deductible as charitable
contributions for federal income tax purposes. However,
they
may be deductible as ordinary and necessary
business expenses. AHAA's Federal Tax ID is
75-2659688.
Agency/Company Profile
All prospective members must fill out this profile. If you are applying as an Associate Member, complete only the information that applies to your company. Prospective General Members must provide two references of existing AHAA members, two vendor references, and credentials of agency principals with this application. AHAA reserves the right to reassign a prospective member to another category.
Agency/Company Name:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Date Founded:
Website:
Key Contact (Voting Representative for General Members):
Name:
Title:
E-mail:
Other Full Service Office Locations:
1. City:
State:
Contact:
Phone:
2. City:
State:
Contact:
Phone:
3. City:
State:
Contact:
Phone:
National Agency Association/Ownership:
Percentage Minority Owned:
%
Parent Company (if any):
%
Hispanic Services Offered:
Advertising
Creative
Promotions
Media
Public Relations
Internet
Other:
Previous Year Capitalized Billings:
Percentage of Hispanic Business:
%
Percentage Non Hispanic:
%
Media Breakdown:
TV%
Radio%
Newspaper%
Magazine%
Outdoor%
Internet%
Other:
Total Number of Employees:
Percentage of Hispanic Employees:%
Major Accounts:
1. Client Since:
2. Client Since:
3. Client Since:
4. Client Since:
5. Client Since:
6. Client Since:
Key Agency/Company Personnel:
1. Name:
Title:
2. Name:
Title:
3. Name:
Title:
4. Name:
Title:
5. Name:
Title:
Please print form and fax to AHAA headquarters at (703) 610-9005.
For Office Use Only
Date Received:________ Amount Paid:__________ Date Paid:___________
