[[Name]]
Affiliated With:[[AKA]]
Member Information Sheet [[currentdate]]
Website [[WebAddress]]
Please review and make any corrections and/or additions. Thank you
Primary Contact: | [[MainContactFull]]
Physical Address: | [[Address1]]
Primary Contact: | [[MainContactFull]]
City: | [[City2]] ST:[[State2]] Zip:[[Zip2]]
Mailing Address: | [[Address2]]
City: | [[City]] ST:[[State]] Zip:[[Zip]]
Billing Address: | [[BillingAddr]]
City: | [[BillingCity]] ST:[[BillingSt]] Zip:[[BillingZip]]
Attn: | [[BillingAttn]]
Phone: | [[PhoneA]] Ext:[[PhExt]] Fax:[[FaxA]] Cell Phone:[[CellPhone]]
Email: | [[EmailAddress]]
Employees FT: | [[FullTimeEmpl]] PT:[[PartTimeEmpl]]
CATEGORIES [[CategoryFee]]
Category 1: [[BusinessCategory1]] Category 2: [[BusinessCategory2]] Category 3: [[BusinessCategory3]] Category 4: [[BusinessCategory4]] Category 5: [[BusinessCategory5]]
Description of Business: (Please limit to less than 50 words and email your description to the chamber)
[[BusinessDescription]]
Current Investments Amount: [[TotalDues]] [[TotalDescrip]]