Member - Palisade Chamber of Commerce

Business Information

Company Name: *

Leave Blank:

Phone: *

Website: *

Email: *

Business Description (200 char max): *

Directory Category: *

Employees:

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Social Networking:

LinkedIn Facebook Twitter Youtube Instagram

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone: *

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook Twitter Youtube Instagram

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone: *

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook Twitter Youtube Instagram

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Business Membership: $175.00
Basic Business Membership Elberta Package: $450.00
Business Membership includes * 12 punch Business After Hours * 2 Business Cards ads in newsletter of choice * Logo with directory listing on www.palisasecoc.com Chairman's Circle Package: $1,500.00
Business Membership includes * 36 Punch Business After Hours * 2 Annual Banquet Tickets * 50% Disc on 2 event tickets of your choice * Enhanced business page with online directory Non Profit Business Membership: $85.00
Basic Business Membership

Additional Opportunities:

We will contact you with additional information.

Business After Hours : $50.00
12 Punch card

Payment Option:

Charge my credit or debit card

Member Application

Mailing Address

Address

Address

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