Texas PTA Web Store - Local Unit Activation

Complete this form to activate your free online payment processing for membership dues and donations. If you don't have a piece of information (and it is not a required field), just leave it blank.

Note: * Denotes Required Fields

	Local PTA Information
	Unit Number (assigned by TX PTA)
	Area Number (assigned by TX PTA)
*	County where your PTA is located:

*	PTA Unit Name:
	PTA Unit Contact Person Information:
*	Contact Title:
*	Contact Name:
*	Email:
	Alt. Email Add.
*	Daytime Phone #:

	Order Processing Information
	Email to receive daily Order Notifications:

	Membership Cost: Enter any that apply.
	Single Membership Cost:
	Family Membership Cost
	Number of Members allowed under family cost.
	Student PTSA Membership Cost:
	Campus Employee Membership Cost:
	Life Member Membership Cost:
	(If you have other membership cost options, please contact your RevTrak Representative)

Check Here if you DO NOT want to accept online donations.

Check here if you USE the dues form to publish a Student Directory.

For security reason, we prefer to mail the check to your PTA unit in care of your campus. If you have a separate PO Box for the PTA and prefer to receive your check there, provide the alternate mailing address for your check. If neither choice works for you, please contact RevTrak for other options.

*	School District:
*	Campus Name:
	Campus Address:
	Campus City:
	Campus ZIP:
	Campus Telephone:

(Only complete if we cannot mail check to the campus)
	PTA Mailing Address:
	PTA Mailing City:
	PTA Mailing ZIP:

I am a current officer of the unit and request you add our unit to the Texas PTA web store. There is no cost to my PTA Unit for this service.
*	Name:
*	Date:

Also consider your OWN web store for your fund raising efforts.

From the Creators of RevTrak… PayOurPTA.com

Karen House - Texas Representative
Email:	khouse@revtraktexas.com
Telephone	817-251-8742
FAX	817-251-8742
Postal address	76051