Membership Application

Greater Belleville Chamber of Commerce

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Business Information

Company Name________________________________________________________________________________

Address _____________________________________ City/State/Zip _____________________________________

Phone ____________________________________ Fax__________________________________________________

E-Mail ________________________________ Website _________________________________________________

Primary Representative ______________________________________ Title ______________________________

Secondary Representative ____________________________________ Title _____________________________

Year Founded _____________ Years at Present Location ________ Number of Employees ____________

Website Membership Category Listings #1:____________________________ #2: ___________________________

Ex: AAA Bank (Listing #1 Finance/Financial Advisors Listing # 2 Banking Associates)

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Annual Investment

Business Partners				Special Partners
□	0-5	Employees	$205	□	Platinum	$15,000
□	6-10	Employees	$280	□	Gold	$10,000
□	11-25	Employees	$390	□	Silver	$5,000
□	26-50	Employees	$475	□	Bronze	$2,500
General Partners				□	Friends of the Chamber	$1,050
				□	Chamber Alliance	$520
□	Civic		$205
□	Individual		$205	□	Associate Partner*	$125
□	Retired		$100		*The addition of a location or additional business to the main membership

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Payment Options

□ Check Enclosed
□ Please charge my Visa or Master Card:
Account #: _______________________________	Name on Card: ___________________________
Expiration Date: ___________________________

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I understand this is an application for membership that must be approved by the Board of Directors of the Greater Belleville Chamber of Commerce

Signature of Applicant ___________________________________________ Date___________

Membership Director_____________________________________________ Date___________

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Please send completed application and payment to:

Greater Belleville Chamber of Commerce, Inc. l 216 East “A” Street l Belleville, IL 62220

Phone (618) 233-2015 l Fax (618) 233-2077 l www.bellevillechamber.org