ONLINE APPLICATION
After submitting the online application please check to: Southwestern Auglaize Chamber of Commerce 107 W. Monroe Steet - Suite 2 New Bremen, OH 45869
Choose your Membership Category: Commercial Industrial Professional Financial Hospital Nursing Home Utilitiy Education Goverment Non-Profit Associate Individual
Business Name:
Contact Name:
Please provide the following contact information:
Street Address
City
State/Province
Zip/Postal Code
Work Phone
FAX
E-mail
Website
Please describe your product or service:
Number of full-time employees:
Number of part-time employees:
Part-time employees divided by 3 =
Total employee count for membership:
Membership base rate .....$
Total employee count:
Amount to multiply your number of employees by ......$
Total costs for employees......$
Number of Associate Memberships:
Number of Associates X $60 =
Total Membership Investment......$
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