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Irvington Chamber of Commerce Membership Application

The undersigned hereby applies for membership investment in the Chamber of Commerce of Irvington, NJ. In consideration of this application being accepted, the applicant shall be entitled to assign one individual as member, for each minimum membership fee. This membership shall renew itself each anniversary, unless resignation is made in writing to the Board of Directors.

The undersigned agrees to abide by the by-laws and make payment of dues in the amount and method specified, in advance, as checked herewith:

Amount: ___ $125.00 (up to 5 employees)
___$125.00 (plus $1 for each additional employee)

Pleae complete the form below and forward it with your check, payable to "Chamber of Commerce of Irvington, NJ", and mail to:

Chamber of Commerce of Irvington, NJ
P.O. Box 323
Irvington, NJ 07111-0323

If you have any questions, please call the Chamber office at (973) 676-8725. You may also pay your dues by major credit card by printing out and faxing the form below to (973) 673-5828.

Contact Name:________________________________________

Telephone #_______________________________________

Fax #_____________________________________________

Email Address________________________________________

Name of Business:_________________________________

Type of Business:_________________________________

Number of Employees: __________

Address:__________________________________________

__________________________________________________

Amount Due:________________

If paying by credit card, complete this portion:

*Note: Your credit card statement will be billed as "FirsTEAManagement" the Chamber's management firm.

______VISA ______MASTERCARD ______AMEX

Account Number:______________________________________

Expiration Date:__________________
Amount Charged______________

Signature of Cardholder_____________________________________