Nebraska Independent Telephone Association C/O Klint Arnold, Treasurer 112 S 5th St., PO Box 113 Pierce, NE 68767 Your membership will become active once payment is received. Please provide the information below for the proper contact at your organization and return a copy of this letter with your payment. Feel free to call me with any questions at 402-329-6225. I thank you for your support of NITA. Company Contact Information: Contact Last Name.: First Name: Company Name .....: Company Address. : City . . . . . . . . . . . : State ....: ZIP.: Phone # . . . . . . . .: Fax # ...: Cell/Mobil#: . . . . . : Email . .: URL . . . . . . . . . . .:
Sincerely, Calvin L. Fluckey President
(Please print and fax to Klint Arnold at 402-482-5700 and then send copy of page with your payment.) Thank you!
