Knightstown Chamber of Commerce Application

Company Name: ______________________________________

Current members are asked to fill out the information on the application and return it to the Chamber.
New members are asked to fill out this application and return it with your check to the Chamber of Commerce.

Principal name: _______________________________________

Title: _________________________________________________

Type of Business: ______________________________________

Additional Representatives & Titles (Please list those who wish to receive mail and want to be a Chamber member)

__________________________________________________________________________

__________________________________________________________________________

Street Address: ____________________________________________________________

P.O. Box: _________________________________________________________________

State & Zip Code: __________________________________________________________

Phone: ________________________________ Fax: ______________________________

E-mail Address: ___________________________________________________________

Web Site Address: _________________________________________________________

Number of Employees:

Full Time: ___________     Part Time: __________

Date Business was Established: _______________

Annual Dues: $50.00

Month/Year joined: _________________________

Signature of Applicant:

__________________________________________________________________________

Please include payment with this form. Return to:
Knightstown Chamber of Commerce
PO Box 44
Knightstown, IN 46148

Support Knightstown, Buy Knightstown, Join Knightstown -- You Can Make a Difference!