Harrison County Chamber of Commerce

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Harrison County Chamber of Commerce Powered By Docstoc
					                                Harrison County Chamber of Commerce
                                                520 West Main Street
                                            Clarksburg, WV 26301-2819
                                      Phone (304) 624-6331 Fax (304) 624-5190
                                          www.harrisoncountychamber.com


                         MEMBERSHIP APPLICATION

Company Name ____________________________________________________

Member Name ________________________________ Title _________________

Mailing Address ____________________________________________________

Street Address (if different) ____________________________________________

City ______________________________ State _________ Zip _______________

Phone ____________ Fax ___________ Email ____________________________

Web site ___________________________________________________________

Number of Employees (FTE) _______ Type of Business ____________________

Description of product/service _________________________________________

Signature ______________________________________Date________________

Annual Investment $_________ (based on number of FTE employees 1-10 $240; 11-20
$290; 21-49 $400; 50-99 $525; 100-199 $620; 200-399 $725; over 400 $1,000; additional
members $200; Home-based business $150; Non-profit $180)

Payment Enclosed ________ Need Invoiced _______ Visa ____ MasterCard_____

Card # ______________________________ Exp. Date _____/_____ CSC#______

Referred by: ________________________________________________________
       Please return completed application to the Chamber office by fax, email or mail.

				
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