|
Application Form Date: ________________________ Name of Principal Chamber Representative: ______________________________________________ Title: __________________________________________ Company: ______________________________________ Address: _______________________________________ _______________________________________________ _______________________________________________ Phone: _________________________________________ Fax: ___________________________________________ E-mail: ________________________________________ Website: _______________________________________ No. of Employees: Full time ____ Part time (F.T.E.) ____ Description of Product or Service: ___________________ ______________________________________________ ______________________________________________ Annual Investment Amount: _______________________ Investment to be paid: ___Annually ___Semi-annually ______________________________________________ Return this form with your check to: Charleston Area Chamber of Commerce |