BUSINESS INFORMATION Business Name ___________________________________________________________________________________ Contact Name ___________________________________________________________________________________ (Published**) Address _____________________________________________________________________________ City _________________________________________________________________ State __________ Zip ________ Telephone ( _______ ) _______ - __________ Fax ( _______ ) _______ - __________ Website _________________________________________________________________________________________ Email Address ___________________________________________________________________________________ Description of Business (30 words or less): Description attached _________________________________________________________________________________________________ _________________________________________________________________________________________________ Number of Employees (part-timers 2 for 1): Full Time __________ Part Time __________ Were you referred by another member? Yes No Member Name _________________________________ Please let us know which member, so we can thank them! Members receive a $25 credit for each referral that joins.
MAILING ADDRESS Same as above Address _________________________________________________________________________________________ City _________________________________________________________________ State _______ Zip ___________ Contact Preference: Email Phone Mail Signature ____________________________________________________________ Date _____ / _____ / ________ Title/Position_____________________________________________________________________________________
SUBMISSION Please submit your application, business description and payment to:
BARTLETT AREA CHAMBER OF COMMERCE
335 S. Main Street, Lower Level of BMO Harris Bank • Bartlett, IL 60103 Please include a one-time administrative fee of $20 | Contact the Chamber for additional payment options Payment Check (enclosed) | Credit Card: Visa MasterCard American Express Amount ____________________________ Expiration Date _____ / _____ / ________ Security code __________ Card Number ____________________________________________________________________________________ Card Billing Address ______________________________________________________________________________ Same as billing address Same as mailing address Signature _______________________________________________________________________________________
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