Business/Organization Name:

Briefly describe your business services and/or products: Example: Friends - Clothing, Jewelry, Home Decor. This information will be added to your business listing within the directory on this web site.

Contact Person:

Physical Address:

City / State / Zip://

Billing Address (if different):

Phone:

Fax:

E-mail Address:

Web Site:

Additional Representative (Optional):
Email Address:
Telephone: Fax:

Additional Representative (Optional):
Email Address:
Telephone: Fax:

To add additional personnel or to make changes to our contact list, email office@chillicothemo.com.

The year your business was established:

Number of Full-Time Employees (including yourself):
Number of Part-Time Employees:

Contact me for Chamber Luncheon Reservations and Announcements by: Email Fax

I would like to be notified in case of a Merchant Alert: By Email By Fax
(suspicious or fraudulent activity reported to the Chamber from the Chillicothe Police or Sheriff's Department, or the Livingston County Prosecuting Attorney)

I would like to sign up as a Chamber Ambassador: Yes No

Become involved to get the most from your Chamber membership. You will be notified about upcoming events and activities and be given an opportunity to serve as a committee member or volunteer.

I understand that by providing the fax number and/or email address above for the business or organization represented in this application, I am authorized to and hereby consent for our business to receive faxes and/or emails from the Chillicothe Area Chamber of Commerce.

Signature:

 Comments, Questions, Suggestions: