Membership Application | Bullhead Area Chamber of Commerce

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Membership Application

February 3, 2012 8:59 pm MST

Yearly Membership Investments
The Chamber year begins each July 1st and ends the following year on June 30th. Therefore, membership investments are pro-rated. Please call the Chamber for your pro-rated membership investment amount. A one-time application fee of $25.00 is required at the time of initial membership.


Login Details:
Username:	*
Password:	*	Capitalization matters. Use 5 to 32 characters
Retype Password:	*
Strength:		Password not entered
Business Details:
Category:	*
Business Name:	*
Website:		ex: http://mydomainname.com
Phone Number:
Fax Number:	*
No. Employees:
Business License #:
Contact Details:
Contact First Name:	*
Contact Last Name:	*
Contact Title:
Contact Email:	*
Retype Email:	*
Mailing Address:		copy address: physical \| billing
Address:
Suite / Num:
City:
State:
Zipcode:
Physical Address:		copy address: mailing \| billing
Street:
Suite / Num:
City:
State:
Zipcode:

Billing Address:

copy address: mailing | physical

Street:

Suite / Num:

City:

State:

Zipcode:

Credit Card Details:

Card Type:

Card Number:

Name on Card:

Expiration Date:

Month:

Year:

Verfication # (CCV):


Company Logo:
Image Upload:		JPG images only. Less that 3mb. Images larger than 250 x 250 will be automatically resized.


Business Description:

I understand that by submitting this membership application, on behalf of the company/organization specified above, that I am authorized to conduct this transaction on behalf of the company/organization and hereby consent for the company/organization to receive faxes sent by or on behalf of the Bullhead Area Chamber of Commerce. Furthermore, I understand that my credit card will be charged a non-refundable, one-time application fee of $25.00.

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