MEMBERSHIP APPLICATION
MEMBER INFORMATION
Company Name:
Phone: Website: Email:
BUSINESS ADDRESS
Address:
Country:_____________ State: _______ City:______________ Postal Code: _____________
MAILING ADDRESS
Same as physical address
Address:
Country: State: City: Postal Code:
BUSINESS INFORMATION
Alabama Business License Number:
Federal Tax ID Number:
Date Business Established in Madison County, AL:
Business Category:
Accounting
Advertising, Marketing & Media
Alternative Medicine/Wellness
Apartments
Automotive
Awards/Trophies
Banking
Beauty Consultants
Breweries
Building & Construction
Business & Professional Services
Catering
Cellular/Wireless Service
Child Care
Churches & Worship
Cleaning Services
Clothing
Computer & IT Services
Cybersecurity
Dance Instruction Defense
Dentists
Eco-Friendly Self-Care
Education
Elder Home Care
Employment
Engineering
Entertainment
Event Venue, Planning & Catering
Financial Firearms
Floral & Gifts
Food & Beverage
Food Truck
Funeral Home/Cemetery
General Contractors
Health & Fitness
Health Care
Home Furnishings
Home Improvement
Home Repair
Hospitals
Individual Industry
Insurance
Jewelers
Landscape/Lawn Care
Legal Services
Occupational
Optometrist/Eye
Pest
PRIMARY CONTACT
First Name: Last Name: Title: Phone: Email:
PRIMARY CONTACT’S ADDRESS
Same as business address Address:
BILLING CONTACT
First Name: Last Name: Title:
BILLING ADDRESS
Same as primary contact Address:
PAYMENT INFORMATION
Card Number: Expiration Date:
CVV/Security Code:
TOTAL AMOUNT DUE:
Should any payment of investment not clear, membership will be suspended until paid in full. The service charge for a returned check is $25 – regardless of the amount of the check, or the reason that it was returned. For credit card or debit payments, a Payment Form must accompany this application. Your membership will be invoiced annually for renewal until written notice has been received.
The Madison Chamber of Commerce reserves the right to decline this application. One of the Chamber’s primary objectives is to foster the development of a dynamic and vibrant local economy. A significant element of the local economy is Federal DOD and National Security activities located on Redstone Arsenal and within the community. Members and their ownership are expected to compliment the growth and development of the Region’s economy.
Incomplete or inaccurate information on this application will be cause for denial of application for membership.
The information about your company may be used for business referral or contact about a business-related activity.
Member Signature: Today’s Date:
Chamber Representative: