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To join,
just print out this form and mail along with your
check to the Pontiac Regional Chamber.
Chamber
President Rosemary Gallardo
402 N. Telegraph Road
Pontiac, MI 48341
(248) 335-9600 Fax (248) 335-9601
email: rosemary@pontiacchamber.com
MEMBERSHIP
APPLICATION
Pontiac Regional Chamber
| Company Name:_______________________________________________ |
| Address:_____________________________________________________ |
| City:___________________ |
State:_______ |
Zip:__________ |
|
| Phone:________________________ |
Fax:___________________________ |
|
Contact Person(s)/Titles:_____________________________________________
__________________________________________________________________
|
| E-Mail:_________@___________________ |
Web Site:http://_________________ |
|
| Please Indicate If: |
___Minority Owned |
___Woman Owned |
___Veteran Owned |
|
| Type of Business: |
___Retail |
___Industrial |
___Professional |
___Service
|
___Individual
|
|
| Describe Type:_____________________________________________ |
|
| Business Hours:____________________________________________________ |
Membership dues may be tax deductible as an ordinary
and necessary business expense, but it is not a charitable tax deduction
for federal income tax purposes. The Chamber is not a charity, but serves
as an advocacy organization for area businesses.
| NUMBER OF
EMPLOYEES |
AMOUNT DUE
|
| 1-10
|
$150.00
|
| 11-50
|
$200.00
|
| 51-100 |
$250.00 |
| 101-250 |
$500.00 |
| 251-500 |
$750.00 |
| 501-OVER |
$1250.00 |
| Government
Agencies/Utilities/Hospitals |
$600.00
|
| Non Profit
Service Organizations & Charities |
$150.00
|
|
Effective July 1, 2003
- sorry, no refunds |
|
Membership is based upon number of employees at your
worksite.
Number of employees _______________Amount Paid__________________
VISA_________ MASTER CARD_______ EXPIRATION DATE______________
Credit Card Number__________________________ Signature________________________________
I hereby apply for membership in the Pontiac Regional Chamber.
I have reviewed the above information and
find it to be true and accurate.
Signature____________________________________________________ Date________
Recruited By_________________________ Recruiter Firm_________________________
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