Membership Application - DeKalb Chamber of Commerce To view this form, please enable JavaScript in your browser. Organization Information (to be displayed online) Organization Name Address 1 Address 2 City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Phone Fax Website Email Main Contact Copy from Organization-Information First Name Last Name Address 1 Address 2 City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Title Phone Email Additional Contacts Contact 1 First Name Last Name Title Email Address Contact 2 First Name Last Name Title Email Address Contact 3 First Name Last Name Title Email Address Contact 4 First Name Last Name Title Email Address Contact 5 First Name Last Name Title Email Address Contact 6 First Name Last Name Title Email Address Contact 7 First Name Last Name Title Email Address Contact 8 First Name Last Name Title Email Address Contact 9 First Name Last Name Title Email Address Contact 10 First Name Last Name Title Email Address Add/Remove Contacts Billing Address (if different) Address 1 Address 2 City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Mailing Address (if different) Address 1 Address 2 City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Membership Investment Membership Type Select one.. ForProfit Business NonProfit & Service Clubs Financial Institutions/Credit Unions Independent/Home-Based Professional Individuals & Retired Business People Business Category None Accountants & Tax Preparation Acupuncture Advertising & Marketing Agriculture Alterations Alternative Medicine Amusements Animal Boarding Animal Removal Animal Shelter Apartments & Housing Appliances & Electronics / Commercial Refrigeration Appraiser Architects Architectural Design Art Gallery Assisted Living / Adult Care Services Attorneys Auto / Truck Rentals Auto Collision Repair & Body Shop Auto Dealers Auto Detailing Automotive / Truck Repair Aviation / Airport Awards / Engraving Awnings Bakery Banquet/Event - Room Rental Barbershops Beauty Salon / Spa / Make-Up Bike Sales / Service Bookstores Bowling Alley Brewery Bridal & Formal Wear Business Consulting Cabinetry / Countertops Camping Experience / Campground Candy & Chocolate Specialties Car Wash Catering Cemetery Chiropractic Services Churches Cleaning Services - Commercial, Janitorial & Restoration Cleaning Services - Residential Clothing Clubs / Organizations CNC Machining Coffee House / Coffee Sales Coin Shop Commercial Inspection Commercial Printing Commercial Rental Property Computer Services / Computer Repair Consulting Engineers Copier Sales Counseling Coworking Space Credit Card Processing Credit Unions Dance School Day Care / Preschool Demolition Services / Dumpster Rental Dentist / Orthodontics Distribution Centers DJ Services Driving School Drycleaners Education Electrical Contractors Electrical Products Employment Services Energy Entertainment Estate Liquidation Events & Event Center / Rental Excavating Facility Products & Services Farm Stand Fiber Optics Financial Institutions Financial Services Fire Safety Firearms Fitness Center / Health Club Flooring Florists Food Manufacturer / Processor Food Pantry Food Truck Framing Funeral Homes / Services Furniture Stores Games Garage Door Services Garbage / Trash Removal Gas Station / Convenience Store General Contractor / Construction Gift Stores Glass / Repair, Replace Golf Courses Government Greenhouse Grocery Store / Supermarket Guitars / Lessons Hardware Store Health Services Hearing Aids / Audiology Heating / Air Conditioning Home Care Providers Hotels / Motels Ice Ice Cream / Frozen Custard / Frozen Yogurt Independent Consultant Individual Industrial / Commercial Roofing Insulation Insurance Interior Decorating / Design Internet Service Providers IT Management / Services Jewelry Landscaping / Lawn Maintenance / Tree Removal Laundry Services Lawn Equipment - Sales & Repair Legal Service Library Liquor Stores Locks / Keys Lumber Machine Shop Magazines Manufacturing Mapping Marketing Services Martial Arts Massage Mattresses Meat Market Medical Centers Mentoring / Coaching Metal Fabrication Mortgage Services Motorcycle Sales / Service Moving Services / Storage Museums Music Store / Lessons / Instrument Sales Musicians / Orchestra Nail Salon Newspapers Nursing Home Obstetrics & Gynecology Office Furniture Office Supplies Optometrists / Opthalmology Orchard Packaging Painter / Painting Supplies Party Rentals / Party Decor / Balloons Paving / Asphalt / Seal Coating Pest Control Pet Services Petting Zoo Pharmacies & Home Medical Equipment Photographers / Videography Physical Therapy / Rehab Services Pizza Plasma Services Plumbing / Septic / Sewer Podiatry Pool & Spa Supplies / Chemicals Popcorn Portable Toilets Power Washing Printing / Graphic Design / Supplies Professional Speaker Promotional Products Property Management Psychic Readings Radio Stations Real Estate / Realtors Recording Studio Recreation Centers Recreation Provider Recycling Remodeling Contractor & Services Resale Residential Builders / Developers Restaurants Restaurants - Bar and Grill / Gaming Restoration Services - Water, Fire, Mold, Smoke Retail Retail - Specialty Retail Roofing / Siding / Windows & Doors Sand Blasting Scrap Processing and Metal Service Center Screen Printing / Embroidery Scuba Diving / Instruction Security Services Seed Distributors Senior Housing Sewing Shipping / Mailing Service Shoes / Boots Shredding Signs Skateboard Shop Smoke Shop Snow Removal Social Service Agencies Student Government Surveyors Tanning Facilities Tattoos & Piercings Telephone / Cell Phone Services & Repair Telephone Directories Theatre Tires / Sales & Service Title Companies Tours / Tourism Towing Transportation / Bus / Taxi / Limo Travel Agencies Tuxedo Sales/Rentals & Formal Wear Utilities / Other Services Vacuum Sales / Service Veterinarians Water Conditioning Water Distributor Web Services / Web Design Web Site Design Wedding Chapel Wedding Services Wholesale Wineries / Wine Sales Number of Full Time Employees Number of Part Time Employees Millions in Assets 110% Club Yes No Annual Membership Investment One-Time Application Fee Total The contents of this box are for testing purposes. This box will be removed when the form goes live. Full-Time Employees Part-Time Employees Hotel/Motel Rooms Restaurant Seats Additional Associates Additional Associates Cost Additional Locations Additional Locations Cost Assets Assets Cost Additional Categories Number Of Additional Categories Additional Categories Cost Additional Item 1 Cost Additional Item 2 Cost Additional Item 3 Cost Additional Item 4 Cost Additional Item 5 Cost Additional Item 6 Cost Additional Item 7 Cost Additional Item 8 Cost Additional Item 9 Cost Additional Item 10 Cost Annual Dues (charged to card) Revenue Item Tax (charged to card) Fee (charged to card) Temp Value For DropDown 1 MembershipType Additional Item 1 Additional Item 2 Additional Item 3 Additional Item 4 Additional Item 5 Additional Item 6 Additional Item 7 Additional Item 8 Additional Item 9 Additional Item 10 Payment Type Credit Card Check NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks. Additional Directory Categories Select additional directory categories below by holding the "CTRL" key Secondary categories may be subject to additional fees none Number of Rooms Number of Seats Number of Associates Number of Locations Tax Additional Items Additional Categories Cost Credit Card Information Copy from Organization Information Credit Card Type MastercardVisaDiscoverAmex Credit Card Number Name on Card Security Code Valid Through 01 02 03 04 05 06 07 08 09 10 11 12 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 Address City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Phone Credit Card Email Address Please click submit only one time. The transaction may take several seconds. Please select a membership type before submitting your application.