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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:

Use Company contact information above.

Address Line 1:	*

Address Line 2:
City:	*
State:	*

Zip:	*

Phone 1:	*

Phone 2:

Fax:

E-mail:	*

Billing Contact Person

Send bills to Primary Contact above.

Prefix:

First Name:

*

Last Name:

*

Suffix:

Familiar Name:

Title:

Use Company contact information above.

Address Line 1:	*

Address Line 2:
City:	*
State:	*

Zip:	*

Phone 1:	*

Phone 2:

Fax:

E-mail:	*

Additional Company Representatives

Add additional representative.

Prefix:

First Name:

*

Last Name:

*

Suffix:

Familiar Name:

Title:

Use Company contact information above.

Address Line 1:	*

Address Line 2:
City:	*
State:	*

Zip:	*

Phone 1:	*

Phone 2:

Fax:

E-mail:	*

Add additional representative.

Prefix:

First Name:

*

Last Name:

*

Suffix:

Familiar Name:

Title:

Use Company contact information above.

Address Line 1:	*

Address Line 2:
City:	*
State:	*

Zip:	*

Phone 1:	*

Phone 2:

Fax:

E-mail:	*

Additional Business Information

Business Category #2:

Business Category #3:

Business Category #4:

*Availiable for Gold and Platinum memberships only. See Investment Level below.

Home Based Business

Walk-in Facility

Minority Owned Business

Woman Owned Business

	How did you hear about the chamber?



	Name of referring individual:

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

Investment Levels

If you are affiliated with another chamber member, please contact Sharon Mayer by calling (972) 727-5585 or via e-mail: sharon@allenchamber.com

Platinum

Gold

Sterling

Silver

Bronze

Basic

FRIEND OF THE CHAMBER **

Administration Fee

$30.00

__________

Total:

$30.00

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