South Windsor Chamber of Commerce

Requires Fields = Red

Please take a few minutes to fill out the following information. We use this information to refer inquiries to your businesses, as well as for billing, event registrations, directory listings and all other contacts we have with you.
Primary Contact:
Name:
Title:
Phone:
Fax:
Email:
Website:
Keywords that describe your business:

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Member Name (This is the Proper Legal Name of the company joining the Chamber)
Member Name:
DBA:
Type of Business:

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Physical Address:
Address:
City:
State:
Zip:

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Mailing Address:
	Check here if the same as "Physical Address". If not then this section is required.
Address:
City:
State:
Zip:

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If your business would like to list additional contacts to receive Chamber mailings, please attached a list to this application including their name, address, phone, fax, and email address.
Name:
E-Mail Address:
Name:
E-Mail Address:
Name:
E-Mail Address:
How did you hear about us?
Did anyone refer you?

Please determine your "Dues Investment" from the schedule below and enter it in the appropriate space.
0-2 Employees: 3-7 Employees: 8-24 Employees: 25-49 Employees: 50-99 Employees: 100-199 Employees: Over 199 Employees:	250.00 $295.00 $330.00 $450.00 $595.00 $800.00 $1,500.00
# of Full Time Employees:
# of Part Time/Seasonal Employees:
Retirees:	$50.00 (for those not associated with a business or government position-retired)
Financial Institutions (Banks & Credit Unions):	$800.00 + $300.00 for each additional branch location
One time New Member application fee: $35.00
$35.00 + Dues Investment = $
A chamber member will contact you for payment and to go over the benefits of being a chamber member.
I want to receive the SWCC E-News via email.
Note Please type the letters and or numbers you see in black into the box before you try to send.