Membership Information Inquiry Form

Company: Contact: Phone #:

Company: Contact: Phone #:

Manufacture liquid asphalt from crude petroleum for any use in the U.S.Manufacture liquid asphalt from crude petroleum for any use in CanadaManufacture liquid asphalt from crude petroleum for any use outside the U.S. and CanadaManufacture liquid asphalt from crude petroleum for any use in multiple countries including U.S.Have liquid asphalt storage and handling facilities.Take title to the liquid asphalt prior to resale.Principal liquid asphalt sales are in the United States.Principal liquid asphalt sales are in the Canada.Principal liquid asphalt sales are outside the United States and Canada.Principal liquid asphalt sales are outside of the United States and Canada, but also sell liquid asphalt tonnage in the United States.

In the asphalt business and purchase liquid asphalt in bulk quantities for application use or for the manufacture of end-use asphalt products. Asphalt roofing shingles, hot mix asphalt, asphalt emulsions, and pipe-coatings are considered end-use products.Primarily a paving company (All of the following statements apply):

• Have a permanent liquid asphalt storage facility in North America with a minimum capacity of 250,000 barrels. (Do not combine multiple facilities to reach this number.)

• Own and operate the storage facility.

• The liquid asphalt storage facility(ies) is its own legal entity.

• Do not resell more than a de minimis amount of liquid asphalt as part of our normal course of business to unrelated third party companies.

Primarily a non-paving company (All of the following statements apply):

• Have permanent liquid asphalt storage facilities in North America.

• Purchase at least 30,000 tons of liquid asphalt annually in North America.

• Do not resell more than a de minimis amount of liquid asphalt as part of our normal course of business to unrelated third party companies

Asphalt sales agents without asphalt assets or facilities and do not take title to the liquid prior to resale.In the asphalt business, working specifically with asphalt related raw material or asphalt additives and principal activity in the asphalt business includes one of the following:Manufacturer or supplier of equipment for the manufacture, storage, transport, or testing of liquid asphalt.Additive manufacturer or supplier.Transporter.Commercial testing laboratory.Terminal operator that provides fee-based terminal services.

Company: Primary Business activity: Phone: Fax: Email: Website:

Address1: Address2: City / Town: State / Province: Zipcode: Country:

Company: City / Town: State / Province: Country: Website: Primary Business activity:

Company: City / Town: State / Province: Country: Website: Primary Business activity: