Neighborhood Retail Alliance
Membership Application*

50 Broadway | 24^th Floor
New York, NY 10004

Phone: (917) 859-3903 Fax: (480) 247-4652 Email: info@momandpopnyc.com

Name:

Store:

Phone:

Fax:

Email:

Website:

Store Address:

City:

Zip code:

Do you live in NYC? Yes No

Number of stores you own:

Number of employees in your store(s):

Are you a member of a Civic/Business Association. If so, which one(s):

If you're a wholesaler, how many businesses do you supply?

* By filling out this membership application you are agreeing to be part of a coalition that will promote small business interests and prevent the proliferation of big-box retailers like Wal-Mart in New York City. If you have any suggestions or would like to take a more active role in the Alliance please send us an email at info@momandpopnyc.com.

Click here for a printable version of this form

Neighborhood Retail Alliance Membership Application*

Neighborhood Retail Alliance
Membership Application*