I'd like more information about membership in the Des Plaines Chamber of Commerce! Fax
Simply print out and complete this form, then FAX to the Des Plaines Chamber of Commerce:
(847) 824-7932. Close window to return to Des Plaines Chamber of Commerce.

Company
Name:_______________________________________________________________________

Address: _____________________________________________________________________

City________________________________ State____ Zip _________________

Authorized
Contact Person:____________________________________________________

Title:_____________________________________________________________

Phone: _______________________ Fax: _________________________

Email: ______________________________________

Business Website
(if applicable) http://_______________________________________

Type of Business: _______________________________________________________

Number of Employees: ______

Referred by: ____________________________________________________

FAX this form to: (847) 824-7932
or MAIL to:

Des Plaines Chamber of Commerce & Industry
1401 Oakton Street
Des Plaines, IL 60018
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