STEP 1 Company Information
Company Name:		Required
Number of Full-Time Employees	1-49 50-99 100 +	Required
Street Address		Required
City/Town		Required
State	AL AK AS AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY	Required
Zip Code		Required
Company Phone		Required
Company Fax		Optional but recommended
Business Description		Required
Website URL		Optional but recommended
General Business E-mail		Optional but recommended
STEP 2 Representative's Information
Title	Chairman CEO President Vice-President Secretary Treasurer Employee Other	Optional
First Name		Required
Last Name		Required
Rep's E-mail Address		Required
Rep's Phone Number		Required
Rep's Fax Number		Optional
Area of Interest		Optional
STEP 3 Payment Information
Total Chamber Investment	$75.00 $150.00 $250.00	Required

Payment Information	PLEASE NOTE: The Total Chamber Investment amount selected above must be remitted to the Chamber in order to complete this member application. The address of the Chamber will appear on the confirmation page.
	© 2005 Jamesburg Area Chamber of Commerce