Issuu on Google+

MEMBERSHIP APPLICATION SUBJECT TO THE APPROVAL OF THE BOARD OF DIRECTORS, I, WE, HEREBY MAKE APPLICATION FOR MEMBERSHIP IN THE PALATINE AREA CHAMBER OF COMMERCE: Date ____________________________

Membership Category:

Regular _____

Nonprofit _____ (Form 501C required)

Premier _____

Firm Name _______________________________________________________

Referred By _______________________________________________________

Physical Address __________________________________________________

City _______________________________________

Zip Code ___________

Mailing Address __________________________________________________

City _______________________________________

Zip Code ___________

Phone ______________________________________

No. of Employees __________

Type of Business ____________________________________________

Website Address _______________________________________________________________________________________________________________________ Company Contact Person ______________________________________________

Email Address __________________________________________________

Additional Contact Person _____________________________________________

Email Address __________________________________________________

Is your business one of the following: Home-Based _____

Woman-Owned _____

Retail _____

Other ________________________________________

Please provide a brief description of your business (no more than 50 characters): _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ In consideration of the approval of the above application for membership. I/We, agree to conform to the by-laws, rules and regulations of the Palatine Area Chamber of Commerce (PACC) either now in effect or to become effective at a future date. Your Membership Dues and/or Other Contributions to the Palatine Area Chamber of Commerce are Non-Deductible as a Charitable Contribution for Federal Income Tax purposes. However, these expenses may otherwise be deductible as ordinary and necessary business expenses. Please consult your tax advisor for a definitive opinion. Membership renews annually on the anniversary date of the first payment. I understand my membership will not start until PACC receives and processes my payment. Dues are nonrefundable. There will be a $25 charge for all returned checks. Automatic renewal: I understand that membership renews annually on my anniversary date of ___________________________, unless notice of prior written cancellation is given to the Palatine Area Chamber of Commerce (PACC) on or before my anniversary date. I agree and authorize the PACC to charge my credit card account or withdraw the monies from my bank account for the amount of my annual dues on or after this anniversary date. In the event my bank account or credit card information changes, I shall advise the chamber prior to my anniversary date. In the event the amount of annual dues changes, timely notice will be given to the member prior to renewal. ____________ (initials)

Annual Membership Dues

$ _________

Administrative Fee

$

Total Due

$ _________

25

We accept: MasterCard _____ Visa _____ Discover _____ American Express _____ Credit Card # _____________________________________________________ Exp. ________________ Name on Credit Card ______________________________________________ Security Code ________ Billing Address __________________________________________________________________________ Signature _______________________________________________________________________________ I have read this contract and agreed to the terms of this membership

MEMBERSHIP INVESTMENT

PREMIER MEMBERSHIP

# OF EMPLOYEES Full Time Equivalent 2 Part-Time = 1 Full Time

Any person, association, corporation or partnership which has an interest in the objectives of the Palatine Area Chamber of Commerce (PACC) and wishes to provide a greater measure of financial support to the PACC shall be eligible to apply for membership as a Premier Member. A Premier Member is a member who voluntarily doubles his/her annual dues. Premier Members are eligible for special recognition as may be awarded by the PACC Board of Directors, and shall enjoy all the rights and privileges enjoyed by Regular or Nonprofit Members.

ANNUAL INVESTMENT

1-5 ...................................................................... $310 6-50 .................................................................... $365 51-100 ............................................................... $490 Over 101 ........................................................... $665 Utility Companies ........................................... $515 Financial Institutions/Banks ......................... $850 Hospitals/Governments ................................ $435 Nonprofit Organizations ............................... $165 (Form 501C required) Additional Community Guide Category Listing ............................................ $25

2016-2017 Community Guide & Business Directory

IL-PAL-CW-16 Design.indd 29

ALL NEW MEMBERS ADD AN ADMINISTRATIVE FEE OF $25 Please return or fax finished form to:

PALATINE AREA CHAMBER OF COMMERCE 579 First Bank Drive, Suite 205, Palatine, IL 60067 Phone: (847) 359-7200 Fax: (847) 359-7246

29 7/1/2016 12:02:16 PM


Palatine IL Community Guide