CHAMBER OF COMMERCE MEMBERSHIP APPLICATION FOR MEMBERSHIP
BUFFALO GROVE AREA CHAMBER OF COMMERCE MEMBERSHIP APPLICATION
Date of Application Company Name Address City
Phone E-mail Address
How (or from whom) did you hear about the Buffalo Grove Area Chamber?
I give permission to the Chamber to e-mail and/or fax information to my company.
Signature State Fax Publish
Web Site Address Contact for Chamber
Your Business Category/Type
Committee Interests Provide a brief description of your business.
Do Not Publish Zip Investment Dues Schedule
(Please note: Investments are prorated as of the first day of the current month.)
Number of Employees* O 1-5
Title
O 6-10 O 11-25 O 26-50 O 51-100 O 101-250 O 250 +
O Charitable orgs, schools, worship O Governmental
Dues Investment
Annual Investment $195
$245 $290 $375 $455 $525 $710 $140 $195
*2 part-time employees equal 1 full-time $
Gold Membership (Optional) Total
_____Credit Card
Visa MC Discover AmEx #
$
_____Check Enclosed Exp.
CID#
Buffalo Grove Area Chamber of Commerce EIN: 36-2834462
We are required by law to inform you that, for income tax purposes your membership dues are a necessary and ordinary business expense, not a charitable contribution. Please note that all memberships are
valid through 12/31/11 and to be renewed on January 1, 2012.
P.O. Box 7124, Buffalo Grove, IL 60089 (847) 541-7799 Fax—(847) 541-7819 E-mail:
info@bgacc.org
Website:
www.buffalogrovechamber.org
28
Buffalo Grove Chamber of Commerce, 50 1/2 Raupp Blvd., (847) 541-7799,
www.buffalogrovechamber.org
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