Des Plaines
Chamber of Commerce & Industry
Membership Application

For accuracy of records, please print out this blank application and then print or type information requested on this application - Thank You.

Company ______________________________________________

Contact ______________________________________________

Title ________________________________________________

Please circle preferred salutation:   Mr.   Miss   Mrs.   Ms.

Address ________________________________________________

City _______________________________  State ___  Zip ________

Telephone   (     ) ___________

Fax   (     ) ________________

E-Mail ______________________@________________________

Number of Employees:   ______ Full-time    _______ Part-time

Business Description __________________________________

______________________________________________________

Standard Industrial Code (SIC) (Optional) ________________

Credit Card No. _______________________________________

Visa     MC          Exp. Date ___ /___

Name on Card: __________________________________________

Signature: _____________________________________________

Membership Investment dues are deductible as an ordinary and necessary business expense. Contributions or gifts to the organization are not deductible as charitable contributions for federal income tax purposes. By submitting this application, you are subscribing to ARTICLE II, Section 3 of the Chamber by-laws which reads: "Members of the Des Plaines Chamber of Commerce & Industry shall attempt at all times to conduct business as members of the community in an honest, professional and ethical manner, and support the principles of customer service."

Please include check made payable to: Des Plaines Chamber of Commerce & Industry, 1401 Oakton Street, Des Plaines, IL 60018 or FAX: 847-824-7932