Member - cm- - Independence Chamber of Commerce

Business Information

Company Name: *

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Phone: *

Website:

Email: *

Business Description (200 char max):

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words):

Who referred you?:

How many years have you been in business?: *

Physical Address

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City: *

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Postal Code: *

Country: *

Mailing Address

Same as physical address

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State: *

Postal Code: *

Country: *

Social Networking:

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Primary Contact Information

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Email: *

Contact Preference:

Email Phone

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:

Email:

Contact Preference:

Email Phone

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

Charter: $7,550.00
Trailblazer: $3,840.00
Truman: $1,450.00
Bingham: $595.00
Osage: $365.00
Pioneer: $150.00
Been in business less than 3 years. Maximum 2 years at this level. 5 or less employees. Individual: $100.00
Student, looking for employment, looking to start a business or retired.

Payment Option:

Bill me Charge my credit or debit card

Member Application

Mailing Address

Address

Address