Member - Fountain Hills 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:

# of Employees: *

Do you want a new member certificate: *

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: *

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook

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:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Copper: $280.00
Basic package first year Bronze: $405.00
First year Gold: $525.00
First year Platinum: $1,075.00
First year Municipal Government: $350.00
First year Friends of the Chamber: $84.00
Non-business affiliated Non-Profit 501c required: $155.00
First year Premier Platinum: $2,575.00
First year

Payment Option:

Charge my credit or debit card

MicroNet Template

Member Application

Mailing Address

Address

Address

Premier