NYACS Retail Membership

New Member Sign Up

Your annual Retail Member dues investment is determined by the number of convenience stores owned and/or operated in New York by your company. This dues investment will activate your membership through 2023.

NYS Store Count *

Total Amount

Email Address *

Retail Company Information

Confirm Email Address *

Company Name *

Primary Contact Person *

Primary Contact Job Title *

Phone *

Website

Street Address *

City *

State *

Postal Code *

Year Company Founded

County(ies) Where You Have Stores

Number of Stores Selling Gas

Gas Brands

Do you hold a valid NYS Sales Tax Vendor certificate? *

Yes No

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *