Repairer Membership Application

SSIA retailer membership dues are $65 for one year. To join, please fill out the form below and press the Register Now button. You will then be taken to another screen with payment options. You will receive an e-mail confirmation when your membership is activated.

Note: Your dues are deductible as an ordinary and necessary business expense, and are not deductible as a charitable contribution.
 
Login Information: For access to the members only section of our site. All fields required. You must provide a valid e-mail address in order to activate your membership.

Email:
Username:
Password:
Password Confirmation:


Business Information

Your Full Name:
Company:
Web Site:
Address:
City:
State:
Zip Code:
Country:
Phone:

Company Description: Enter a brief description of your company below. Limit 400 characters. This is what your customers will see when searching our site. Keep in mind they will already have your contact information, so use this description to cover services, company history, company philosophy, etc.
 

Social Media Information: If you have Facebook, Twitter or LinkedIn accounts you would like to share with your customers, include them below. Please copy and paste the complete url of your page (beginning with https://).

Example: https://www.facebook.com/fastfeetshoerepair

These links will be included in SSIA's store locator.
Facebook:
Twitter:
LinkedIn:


Anti-Spam Check: Please type in the verification code shown below.

Verification Code:
Re-Enter Verification: