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New Member Application

Company Information

Company:

*

Address Line 1:

*

Address Line 2:

City:

*

State:

*

Zip:

*

Phone 1:

*

Phone 2:

Fax:

E-mail:

*

Website:

Full-time Employees:

*

Part-time Employees:

*

Create Member Account Login

Your member account allows you to update your information online via a secure login.

Admin E-mail:

*

Password:

*

Verify Password:

*

Contacts

Primary Contact

Prefix:

First Name:

*

Last Name:

*

Suffix:

Familiar Name:

Title:

Create Login

Your member login allows you to update your information online and register for events.

Username:

*

Password:

*

Verfiy Password:

*

Use Company contact information

Billing Contact

Send invoices to Primary Contact

Additional Company Representatives

Additional Representative

Add additional Representative

Additional Representative

Add additional Representative

Business Information

Business Category 1:

Business Category 2:

Business Category 3:

Does your business quality as any of the following?

Home Based Business

Historically Underutilized Business

Minority Owned Business

Woman Owned Business

How did you hear about the chamber?

Please indicate your expectations or greatest value to be provided through membership with the Allen-Fairview Chamber of Commerce.

Investment Levels

Application Fee:

$30.00

Total:

$0.00

Pay via Credit Card

Pay via Corporate Check - My company/organization requires chamber membership payment(s) to be paid via Corporate Check and has received approval from the Allen-Fairview Chamber of Commerce to do so.

I agree to the Member Code of Conduct and understand that membership dues are non-refundable. **

Security Code:

Please enter the security code above.

**

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