Application | Pryor Area Chamber of Commerce

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Application

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Business / Organization Information

Business/Organization

Phone Number

Website

Business Description

Business Keywords

Comments / Questions

Physical Address

Address 1

Address 2

City

State

Zip

Is your Mailing Address the same as your Physical Address? SameDifferent Mailing Address

Mailing Address (if different)

Address 1

Address 2

City

State

Zip

Primary Contact Information

First Name

Last Name

Title

Phone

Cell Phone

Additional Contacts

Contact 1

First Name

Last Name

Title

Email Address

Phone

Contact 2

First Name

Last Name

Title

Email Address

Phone

Contact 3

First Name

Last Name

Title

Email Address

Phone

Contact 4

First Name

Last Name

Title

Email Address

Phone

Contact 5

First Name

Last Name

Title

Email Address

Phone

Contact 6

First Name

Last Name

Title

Email Address

Phone

Contact 7

First Name

Last Name

Title

Email Address

Phone

Contact 8

First Name

Last Name

Title

Email Address

Phone

Contact 9

First Name

Last Name

Title

Email Address

Phone

Contact 10

First Name

Last Name

Title

Email Address

Phone

Is your Billing Contact the same as your Primary Contact? SameDifferent Billing Contact

Billing Contact Information

First Name

Last Name

Title

Email Address

Phone

Cell Phone

Is your Billing Address the same as your Mailing Address? SameDifferent Billing Address

Billing Address (if different)

Address 1

Address 2

City

State

Zip

Membership Investment

Membership Type

Primary Directory Category

Additional Directory Categories

Select additional directory categories below by holding the "CTRL" key
Secondary categories may be subject to additional fees

Number of Full Time Employees

Number of Part Time Employees

Number of Rooms

Number of Units

Millions in Assets

Preferred Partner ($100)

Annual Membership Investment

Additional Items

Additional Categories Cost

One-Time Application Fee

Total

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Number of Associates

Tax

Number of Locations

Full-Time Employees

Part-Time Employees

Hotel/Motel Rooms

Restaurant Seats

Additional Associates

Additional Associates Cost

Additional Locations

Additional Locations Cost

Assets

Assets Cost

Additional Categories

Number Of Additional Categories

Additional Categories Cost

Additional Item 1 Cost

Additional Item 2 Cost

Additional Item 3 Cost

Additional Item 4 Cost

Additional Item 5 Cost

Additional Item 6 Cost

Additional Item 7 Cost

Additional Item 8 Cost

Additional Item 9 Cost

Additional Item 10 Cost

Annual Dues (charged to card)

Revenue Item

Tax (charged to card)

Fee (charged to card)

Temp Value For DropDown 1

MembershipType

Additional Item 2

Additional Item 3

Additional Item 4

Additional Item 5

Additional Item 6

Additional Item 7

Additional Item 8

Additional Item 9

Additional Item 10

Payment Type

NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.

Credit Card Information

Credit Card Type MastercardVisa

Credit Card Number

Name on Card
Security Code
Valid Through
Address
City
State
Zip
Phone
Credit Card Email Address

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Please select a membership type before submitting your application.

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