Business Info (To be used in Membership Directory)

Business Name*

Business Phone*

Business Address*

Street Address Address Line 2 City State ZIP Code

Is the business and mailing address the same?*

Mailing Address

Street Address Address Line 2 City State ZIP Code

Website

Directory Classification*

California State ID (SEIN)

Direct Contact Info

Contact Name*

First Last

Phone*

Phone Extension

Email*

Please list Chamber representative who helped you with the membership process

Have membership contact me about:

Committee Options

Total

$0.00

Comments

This field is for validation purposes and should be left unchanged.