Membership Application
”Your
Invitation to Invest”
Business
Name________________________________________ Date______________
Business License Number of Tax ID
Number___________________________________
Primary Contact Name
(Mr./Mrs./Ms.)________________________________________
Additional
Representatives_________________________________________________
Physical
Address________________________________________________________
Mailing Address (if different)________________________________________________
Phone________________________________________ Fax______________________
E-mail_____________________________
Web Site_____________________________
Preferred Method of Contact
ð
Email
ð
Fax
ð
Mail
Brief explanation of Business (max.
50 words)_________________________________
______________________________________________________________________
_______________________________________________________________________
Business
Category_______________________________________________________
(to
be approved by Membership Manager)
Please fill in appropriate
information according to investment schedule
Membership Investment Schedule
Full
Time Employees__________ Part Time Employees__________
Units___________
Customers____________ Dealerships____________ Licensed
Professionals________
Processing Fee $25.00 Total
Investment_____________________
Method of Payment:
ð
Check Enclosed
ð
Visa
ð
MasterCard
ð
American Express
Card
Number____________________________ Expiration
Date___________________
Member Signature _______________________ Membership Sponsor
______________
Please sign me up for:
___ Ambassadors
Club
___ Governmental
Affairs Committee
___ Education Committee
___ Golf Tournament Committee
___ Holiday
Parade Committee
___ Women's
Business Roundtable
___ Small Business Committee
___ Military Affairs Committee
Return to:
Jacksonville*Onslow Chamber of
Commerce, PO Box 765,
Jacksonville, NC 28541-0765
Fax (910)347-4705
