Membership Application

First Name: Initial: Last Name:

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About Your Business (If you do not have business,skip to the next section.)

Company (if any): Business Title:

Business Address: Business Address 2:

City: State: Zipcode:

Business Phone: Ext.

Alt. Business Phone: Fax:

Business Email:

Type of Business (example: Grocery Store, Real Estate, etc.)

Are you the owner of the business?

Yes
No

How long has the company been in business?

Bank:

Insurance Carrier

Which of these does your company fall into?

DBA
Corporation
Partnership

Do you have a CPA or Accountant?
CPA
Accountant

Do you have a Business Plan?
Yes
No

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Personal Information (please make sure you insert your email)

Residential Address:

Residential Address 2:

City: State: Zipcode:

Home Phone: Cell Phone:

Email: (if same as above, leave blank)

Ethnicity:

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Membership Desired

Thank you for taking your time to fill out the online membership application. In order for this application to be processed ALL FIELDS MUST BE FILLED. If you need assistance, please contact someone at our office 746-1989 or email miguel@masslatinochamber.com.