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Membership Request Form

CONTACT INFORMATION

 
First Name *
Address1 *
City
Mobile / Primary Phone
Business Type
Business Type if "Other"
Company Name *
Last Name
Address2
Zip Postal *
Secondary Phone
Business Website
Preferred myAGWAY location:
 

 

Credit Card Information*

As an added service, we offer our members Express Payment. If you would like to participate, please check the box below, and we will send you the appropriate credit card forms that we can keep on file. *This is not a requirement for program membership.

 

 

REFFERAL PROGRAM

How did you hear about Pro's Advantage? (check one):

referral recognition

Please share the name and/or business that referred you - they deserve our sincerest thanks:

 
First Name:
Primary Phone:
Business Name:
Last Name:
Email:
 

You could earn a $50 gift card for each friend or colleague you refer that becomes a Pro's Advantage member. Simply share a little information about the businesses you think would benefit from our quality selection, service, convenience, and expert product knowledge:

 

Referral 1 Info

Referral's Name
Business Name
Primary Email
Primary Phone
Business Type

Referral 2 Info

Referral's Name
Business Name
Primary Email
Primary Phone
Business Type
 

Please note: your privacy is very important to us. We will never share your information with a third party vendor. If you have any questions about this form, or the Pro's Advantage program, please send us an email.

* Referral rewards are paid out at the discretion of myAGWAY management, based upon new myAGWAY customers who join the Pro's Advantage program.

A manager will contact you within 2 business days to confirm your membership status and discuss your business needs. Please use the links below to email your tax documents to the appropriate myAGWAY location.

Send tax forms

Use the links below to send a Word Doc or pdf file of your business Tax Forms to your preferred myAGWAY location.

Bethel manchester middlefield NORTH haven N. BRANFORD SOUTHINGTON

To learn more, call one of our 6 stores, and ask to speak with a manager:

Bethel
74 South St
203.743.3232
manchester
33 Adams St
860.643.5123
middlefield
147 Meriden Rd.
860.347.7229
NORTH haven
66 State St.
203.239.1687
N. BRANFORD
11 Whitewood Ln
203.483.7800
SOUTHINGTON
1198 Queen St.
203.239.1687
 
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