Join Us - Rockford Chamber of Commerce

Business Information

Business/Organization Name *

Date Established *

Number of Employees *

Main Contact Information

Main Contact *

Will be used as the primary contact for Chamber membership.

Main Contact E-mail *

Main Contact Phone Number *

Preferred Contact Method for Main Contact *

E-mail

Mail

Website Listing Information

Website Contact (if different than Main Contact)

Will be listed on the Chamber website as the business contact.

Website Contact Email

Website Contact Phone Number

Company Description *

To be used on business listing on Chamber website. 100 words or less.

Company Website URL

Company Address

Address *

Address Line 2

City *

State *

Postal Code *

Billing Information

Billing Address

(Check if billing address is same as above)

Billing Address

Billing Address Line 2

Billing City

Billing State

Billing Postal Code

Billing Contact Name

Billing Contact Phone

Billing Contact E-mail

Preferred Contact Method for Billing

E-mail

Mail

If different than Main Contact preferred method

Other

How did you hear about the Chamber?

What lead you to join the Chamber? (Check all that apply)

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Business Information

Main Contact Information

Website Listing Information

Company Address

Billing Information

Other

Membership Level

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