Application

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Organization Information (to be displayed online)

Organization Name

Address 1

Address 2

City

State

Zip

Phone

Fax

Website or Facebook Address

Main Contact

Copy from Organization-Information

First Name

Last Name

Address 1

Address 2

City

State

Zip

Title

Phone

Additional Contacts

Contact 1

First Name

Last Name

Title

Email Address

Contact 2

First Name

Last Name

Title

Email Address

Contact 3

First Name

Last Name

Title

Email Address

Contact 4

First Name

Last Name

Title

Email Address

Contact 5

First Name

Last Name

Title

Email Address

Contact 6

First Name

Last Name

Title

Email Address

Contact 7

First Name

Last Name

Title

Email Address

Contact 8

First Name

Last Name

Title

Email Address

Contact 9

First Name

Last Name

Title

Email Address

Contact 10

First Name

Last Name

Title

Email Address

Add/Remove Contacts

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 Units

Millions in Assets

Enhanced Listing - $40
Your directory entry on our website will be enhanced with:
a description of your business,
your logo,
2 photos,
hours of operation,
areas served,
social media connections,
and more!

Additional Employee Listing - $45
One contact person is standard in our directory listings. This enhancement is for each additional representative you want to list.

Featured Listing - $30 (cost per quarter)
Your business listing will be featured on the Directory Homepage for three (3) months

Annual Membership Investment

Additional Items

Additional Categories Cost

Total

The contents of this box are for testing purposes. This box will be removed when the form goes live.

Tax

One-Time Application Fee

Number of Associates

Number of Seats

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

Enhanced Listing

Additional Employee Listing

Featured Listing

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

Membership Type

Web Link - $20
The website or Facebook page you use for your business will be linked in your directory entry on our website.

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

Copy from Organization Information

Credit Card Type MastercardVisaDiscoverAmex

Credit Card Number

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

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Manchester Area Chamber of Commerce

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