Membership Application - Beaver County Chamber of Commerce

Member Investment Structure
	Number of Employees	Annual Dues
	1-10	$210.00
	11-25	$240.00
	26-50	$265.00
	51-75	$290.00
	76-100	$315.00
	101-200	$370.00
	210-300	$420.00
	301-400	$475.00
	401-500	$525.00
	500-600	$780.00
	600+	$1,500.00
Please remember to add the one-time initiation fee of $25.00

Company Name:

Contact Name:

Title:

Business Address:

City:

State: Zip:

Phone Number:

Fax Number:

Email Address:

Website Address:

Number of Employees:

Tax ID#: :

Business Category:

Company Established Since:

Facebook Business Name

Please provide a brief description of what your business does:

What makes your business different?

What are your primary reasons for joining the Chamber?

Would you like to offer fellow Chamber members a discount?

Referred By:

Signature:

Date: