Brockville and District Chamber of Commerce Application Form
Company:
Address:
City:
Postal Code:
Telephone:
Toll Free:
Fax:
E-mail:
Website:
Preferred Methood of Contact:
E-mail
Fax
Mail
Number of Employees (2 P/T = 1 F/T):
Business established in (year):
BUSINESS CATEGORY:
1. Choose one:
Service
Retail
Manufacturing
Wholesale/Distribution
2. Choose one:
Home Based
Small Business
Business (15+)
Institution
Industry
3. Choose as many as apply:
Downtown
Professional
Multi National
Tourism-Oriented
Non Profit
Government
Independent
Hospitality
Franchise
Business Directory Listing:
One word that best describes your business
(your yellow page word)
Business Directory Description:
30 words or less to describe your business in the directory
M2 Benefit Program:
Yes
No
Would you like to take advantage of the opportunity to offer an exclusive benefit or discount to Chamber Members and their employees?
If yes, please describe:
Contacts:
*Please include their full name, title and e-mail*
Contact 1:
Contact 2:
Contact 3:
Contact 4:
How were you made aware of the Brockville and District Chamber of Commerce?
Please state your main reason for wanting to join the Chamber:
