Member Application

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category:

Employees:

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Annual Basic Membership: $250.00
Standard membership package Business + Investor Package: $750.00
Standard membership package plus marketing benefits of Chamber Signature Events Silver Investor Membership Package: $1,500.00
Standard membership package plus elevated marketing benefits of Chamber Signature Events AND logo displayed on Chamber website

Payment Option:

Bill me Charge my credit or debit card

Print Application

Printed courtesy of foxwestchamber.com/ – Contact the Fox West Chamber of Commerce for more information.
P.O. Box 132, Greenville, WI 54942 – 920-931-2925 – marketing@foxwestchamber.com