ILLBA Membership Application
Thank you for your interest in the ILLBA! Company information provided on this form will be added to the ILLBA website.
Company Name
*
DBA Company Name (if applicable)
Name
*
First Name
Last Name
Title
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
ILLBA Representative (if different from above)
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Title
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Toll-free Number
Please enter a valid phone number.
Format: (000) 000-0000.
Company Website
Vehicles - please indicate the number of vehicles operated by type.
*
Rows
Total
Sedan
SUV
Stretch Limousine
Mini Van
Executive Van
Limo van or bus
Mini bus
Motorcoach
Trolley
Wheelchair accessible
TOTAL VEHICLES
Are you a member of the National Limousine Association (NLA)?
*
Yes
No
Service Areas: please list the major airport codes primarily serviced by your company (up to 5)
*
Do you operate a reservation system? If so, please indicate the software (ex., Limo Anywhere, Hudson, Livery Coach, custom built or NONE)
*
Are you using GNET/GRIDD
*
Yes
No
Signature: I certify that the above information is true and correct
*
Print Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Annual Membership Dues
*
1-4 Vehicles $100.00 USD
5-10 Vehicles $200.00 USD
11-25 Vehicles $300.00 USD
26-50 Vehicles $400.00 USD
51+ Vehicles $500.00 USD
Associate Member (outside IL, IN, WI) $100.USD
Submit
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