Chamber of Commerce Application Form Join the Norwin Chamber of Commerce Application Form Company or Business Name:*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Best time to call phone:MorningAfternoonEveningMobile Phone NumberBest time to call phone:MorningAfternoonEveningFax NumberWebsiteOwnerDate Established Date Format: MM slash DD slash YYYY Primary Contact Person* First Last Primary Contact E-mail Address:* Person to be listed in the Membership Directory*Please select the Business Category that best describes your business*SelectAccountingAdvertising/Marketing/PRApartments/RentalsApparel (Silk Screening & Embroidery)Appliance Dealers/RepairsArts & CultureAssociation & Organizations (Nonprofit & For Profit)Athletic Clubs/Fitness CentersAutomotive ServicesBanks/Credit UnionsBuilding ContractorsBusiness Opportunities & FranchisingBusiness ServicesCar DealershipsCar WashCarpentersCarpet CleaningCatering/Food ServiceCemeteryCharitable OrganizationsChiropractorsCleaning ServicesCommercial Art/Graphic DesignCommunicationsComputersConcreteConstructionConsulting ServicesCosmeticsCounseling & Social ServiceCredit Card ProcessingDeli/Grocery StoreDentistry/OrthodonticsEducational Services & InstitutionsElected & Public Officials/GovernmentElectriciansEmployment ServicesEngineeringEnvironmental ServicesEquipment RentalFinancial Services/InvestmentsFlooringFloristFood Wholesalers/DistributorsFuneral HomesFurniture & Fixtures - Home/OfficeGarage Doors/Sales & ServiceGolfHealth & Wellness Products and ServicesHealth ProfessionalsHeating & Air ConditioningHome InspectionHome RepairHome-Based Businesses/Home PartiesHospitals/Medical FacilitiesIce CreamIncome Tax PreparationIndividual MemberInsurance Agents, Brokers, CarriersInternet/Website ServiceJewelryLandscape Contractors/SuppliersLawn & Garden ServicesLegal ServicesLibrary/Library ServicesLodgingMaintenance/Janitorial ServicesManufacturing & Distribution Misc. ProductsMedical BillingMembership OrganizationsMunicipalitiesMusic/Related ServicesNewspapers/Magazines/PublishingNurseries/GreenhouseNursing Home/Assisted LivingOffice Supplies/ Office EquipmentOptometrists/OphthalmologyPaintingPayroll ServicesPet Grooming/Pet ServicesPharmacyPhotographyPhysical Therapy/Rehabilitative ServicesPlumbingPool Supplies & ServicePrintersPromotional ProductsReal Estate (Commercial & Residential)Religious InstitutionsRestaurants/Banquet Facilities/NightclubsRestoration ServicesRetail Specialty StoreRetail Warehouse ClubSalons & SpasSecurity/Alarm ServicesSenior Services/Home Care ServicesShipping ServicesSignsSpecialty FoodsSports Organizations/Sporting Goods/Sports CoachingStorage & MovingStudent MemberTanningTransportationTravelUtilities & Related ServicesVending ServicesVeterinary Hospital/VeterinarianVideo Production/MultimediaWaterproofing/RestorationWholesalers/DistributorsWindow CleaningWineryOTHER ATTENDING PERSONNEL1. Name: First 1. Contact E-mail Address: 2. Name: First 2. Contact E-mail Address: 3. Name: First 3. Contact E-mail Address: Number of Employees:*Number of Part Time Employees*BUSINESS DESCRIPTIONPlease give a brief description (50 words or less) of your business:*Referred By:*Reason for joining the Chamber:Annual Investment Rates*1-15 Employees ($220.00)16 - 49 Employees ($385.00)50+ Employees ($690.00)Non-Profits* ($155.00)Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name EmailThis field is for validation purposes and should be left unchanged.
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