New Member Application
(*) Denotes Required Fields
Company Information
Company: *
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
Web Site:
Online Links:
Business Category #1:
Please contact us with questions regarding business categories.
Full-time Employees:
Part-time Employees:
Members-only Access
Members-only allows you to update your information online via a secure login.
Admin E-mail: *
Password: *
Verify Password: *
Primary Contact Person
Prefix:
First Name: *
Last Name: *
Suffix:
Familiar Name:
Title:
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
Billing Contact Person
Prefix:
First Name: *
Last Name: *
Suffix:
Familiar Name:
Title:
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone 1: *
Phone 2:
Fax:
E-mail: *
Additional Business Category(s)
Business Category #2: $0.00
Business Category #3: $0.00
Business Category #4: $0.00
Business Category #5: $0.00
Additional Information
Are you a veteran-owned business?
Membership Investment Rates**Annual Membership starts date of Joining
Memberships that include multiple locations are subject to an additional charge of $100 per location. Please contact Meaghan Doherty at meg@plymouthchamber.com if you have multiple locations and would like to join the chamber.
Onetime Application Processing Fee:$25.00
__________
Total:$275.00
(*) Denotes Required Fields

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