Application

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New - Member Application

Are you a new or returning member? *

New Member
Returning Member (Complete this form so that we may have your most current information on file)

Company Name *

Contact Name *

First

Last

Contact Name Title *

Business Street Address *

City *

State *

Zip Code *

Phone *

Email *

Website

Billing Address (If different)

Number of Employees (Part Time)

Number of Employees (Full Time)

Date Business Was Established *

County of Business *

NAICS Code *

If Referral Was Other, Please Explain Here

Reason for Joining *

About Your Company, Products, Services, etc, *

Social Media: Facebook

Social Media: Twitter

Social Media: Other

Membership Classification *

Payment Options

Please send me an invoice
I will send a check made payable to Spencerville Chamber of Commerce

Digital Signature *

First

Last

Date Signed *

Additional Comments or Messages

Application Information: Please make all checks payable to: Spencerville Chamber of Commerce

Please send payment in the form of a check to:
Spencerville Chamber of Commerce
PO Box 33
Spencerville, OH 45887

Special Note: Please send a logo or image to info@spencervillechamber.org to be used along side your information that will be displayed on our website, www.SpencervilleChamber.org.

This information will be used by the Spencerville Chamber of Commerce. Some of this information may be placed on our website, www.spencervillechamber.com, where it will be accessible to the public.
Your annual membership dues to the Spencerville Chamber of Commerce may be tax deductible as a business expense, but not as a charitable expense. Please check with your tax advisor for more details.

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