Join The New Britain Chamber Today!

Please print and complete this form and return it to the Chamber. All membership applications
must be completed and accompanied by a check or credit card information.

Company Name:

_________________________________________

Contact Person Name:

_________________________________________

Your Phone & Email (if applicable):

_________________________________________

_________________________________________

Additional People To Put On The
Mailing List (if applicable):

_________________________________________

_________________________________________

_________________________________________

Address (street, city, state & zip):

_________________________________________

_________________________________________

Main Phone & Fax At Office:

_________________________________________

_________________________________________

I Want To Offer A Discount To Other
Chamber Members. My Offer Is:

_________________________________________

_________________________________________

Web Page Address:

_________________________________________

Number of Employees: _________________

Business Category:
(please describe your business & products)

_________________________________________

_________________________________________

_________________________________________

Annual Dues Investment: _________________

Sponsor: _________________


Form Of Payment: ____ Check Enclosed ____ Credit Card


Credit Card: ____ Mastercard ____ Visa ____ Amex

Card Number:

_________________________________________

Expiration Date: _________________

Name as it appears on card:

_________________________________________

Signature:

_________________________________________


New Britain Chamber Of Commerce
One Court Street, New Britain, CT 06051 		Tel: 860-229-1665
Fax: 860-223-8341

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