Chamber Information

Membership Investment Agreement Form

Business Information  
Business Name
Address
City
State
Zip
Telephone
Fax
Web Site Address
E-Mail Address
Name of Business that checks
are drawn on
(if different than above):
Please Describe your Business (25 words or less):
   
Payment Schedule  
Full Time Equivalent Employees:
Calculation: Total payroll hours per week/40 ( includes management )
Annual Dues:
Administrative Charge:
Total Payment:
Payment Schedule:
Payment Method:
Credit Card Number:
Exp: /
3-digit Security Code
Membership is effective upon receipt of payment:
   
Additional Information  
Primary Business Representative
First Name:
Last Name:
Additional Representatives (please include address, phone number and e-mail address if different )
Name
Address
Phone Number
E-Mail
Name
Address
Phone Number
E-Mail
Name
Address
Phone Number
E-Mail
Business Categories (3 at no charge; 3 additional at $25 each per year):