CRESTVIEW AREA CHAMBER OF COMMERCE
502 SOUTH MAIN STREET, CRESTVIEW, FL 32536-4250
(850) 682-3212  n FAX:  (850) 682-7413

MEMBERSHIP APPLICATION

I desire to participate in promoting the business environment and economic
development of the Crestview Area and North Okaloosa County. Application is
hereby made for membership in the Crestview Area Chamber of Commerce. I
understand that payment for membership dues must accompany this
application.

Date of Application:

For Profit:          Not For Profit: 

Primary Investment
See membership level

$

Associate Investment
$100 per person

$

$25 Enrollment Fee
One time charge
New members only

$

Total Investment

$

Name of firm:

 Number of employees:

 

(Please print or type)

 

(Including self)

Type of Business:

 

(Retail, wholesale, insurance, etc.)


Primary Representative:

 

(Please print or type)

Physical Address:

 

(Not a Post Office Box, this will be used for directory purpose)

City: St: Zip:

 

 

Mailing Address:

 

(If different from above)

City: St: Zip:

 

 


Phone: Fax: E-Mail:


Web Site Address:


Associate Member:

 

(Please print or type)

* Would you like a ribbon cutting?  Yes        No

If so, approximate date:  Time:

Official Chamber ribbon cutting must be held Monday-Friday and should be scheduled at least two (2) weeks in advance for
widest possible advertisement and notification. Local press, TV and radio require two weeks notice for Public Service Announcements
(PSA).

Chamber membership is a continuing investment and is to be renewed automatically each year until written resignation is
submitted to the Board of Directors or after 90 days of non-renewal payment.

Membership investment in the Crestview Area Chamber of Commerce may be tax deductible as an ordinary business
expense. Chamber dues are not a charitable tax deduction for federal income tax purposes. The Chamber is a private
not-for-profit business organization and is not part of the local or state government.


Your membership investment may be paid by CASH, CHECK, MONEY ORDER, VISA, MASTERCARD OR A
MONTHLY DEBIT FROM YOUR CHECKING ACCOUNT.


Signature: ______________________________________________________________ Date: ________________

Referred by: ____________________________________________________________

For Office Use Only.

Plaque sent/received?  Yes   No

*Exceptions (circle one):     Clubs, Non-profit organizations, schools, churches, Home-based businesses, individual and associate members




Date plaque sent: _______________________________

Date Application received: _______________________________

Type of Payment (circle one):     Cash         Check         MasterCard         Visa         ACH (Auto Debit)


Check # _______________________________ and amount _______________________________