Complete the form below and a team member will contact you regarding the next steps. A PDF application form is also available. For questions, please email

If you are joining as an Affiliate or Friend-level member, please complete the PDF application form.


Note: A one-time $50 initiation fee applies to new members. Prorated membership dues are billed annually according to our fiscal year: June 1st through May 31st the following year. Up to $99 of your annual dues may go to AgPAC/UnitedAgPAC, UnitedAg’s political action committees.

Company Information


An email receipt of this form will be sent to this email.

Check all that apply.

Enter the top three commodities.

Ex: Marketing
Ex: Machine Equipment
Ex: Sales

Please list one per line.

Contact Information
President / CEO
Human Resources Director
Operations Manager
Accounting Manager
Additional Contact
Billing Contact
Authorized Company Representative
Service Representative

Fiscal Year begins June 1st and ends on May 31st the following year


If paying by Check, please make it payable to "United Ag" and send to:
Attention: Accounting Department
54 Corporate Park
Irvine, CA 92606

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Please enter your initials to indicate your digital signature.

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