Retail Gasoline Dealers Association
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Contact First Name
Contact Last Name
Title/Position
Contact's Phone Number
E-mail Address
Username
Password
Confirm Password
Business Information
Business Operating Name
Business Legal Name
Business Type
Gas Station
Convenience Store with Fuel Sales
Fuel Distributor
Independent Retailer
Corporate Store
Franchisee
Business Owner Name
Store Phone Number
Website URL
Street Address
Number of Locations Operated
Please complete the names and address of your other locations below:
Number of Employees
Wholesaler
Store Brand
Are you on Rack or Regulated Margin?
Rack
Regulated Margin
Would you like to participate in our quick weekly survey calls for Service Nova Scotia?
Yes
No
Why Do You Want to Join the RGDA?
I confirm that the information provided is accurate and complete, agree to abide by the RGDA Code of Conduct and Membership Terms, and understand that submission of this form does not guarantee membership approval.
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