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To The Directors: Please review this electronically submitted application to the Suburban Essex Chamber of Commerce for membership and along with a payment of $175 for businesses (under 50 employees) $300 for businsses (over 50 employees), $400 for banks and/or hospitals, $175 for additional branches within each town, $50 for civic membes and $25 for patrons. Payment constitutes the annual dues. A one time only administration fee of $25 applies in addition to payment. The applicant agrees that if this application is accepted, he/she will conform to the requirements of the by laws of the Chamber of Commerce.

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Company Name: *

First Name: *

Last Name: *

Title:

Address1: *

Address2:

City: *

State: *

Zip Code: *

Business Description, Business Tagline, Additional Officers & Staff:

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Business Type: *

Phone: *

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Fax:

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Website:

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Number of Employees:

Tax ID. No.:

Vice President:

# of Full Time Employees:

Membership: *

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A one time only administration fee of $25 applies in addition to payment.

Membership Type: *

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