Test Page COMPANY INFORMATION (as you want it to appear online & in publication) Company Name* Physical Address* Physical City* Physical State* Physical Zip* Business Telephone* Website URL Business Email* Billing Address (if different)* Billing City* Billing State* Billing Zip* CONTACT INFORMATION Primary Contact* Primary Contact Title* Primary Contact Email Primary Contact Telephone* Preferred Method of Contact* EmailPhoneText Billing Contact* Billing Contact Title* Billing Contact Email Billing Contact Telephone* Other Contacts Please list any other employees who should receive our e-newsletter. Other Contact #1 (Name) Other Contact #1 (Email) Other Contact #2 (Name) Other Contact #2 (Email) Other Contact #3 (Name) Other Contact #3 (Email) Other Contact #4 (Name) Other Contact #4 (Email) BUSINESS INFORMATION Type of Business* For ProfitNot-For-Profit/School/GovernmentIndividual/AssociateSecond Business If this is a second business, please list your primary business: Listing Category (see list)* 20-Word Business Description (for listing on the Chamber website)* Number of Employees All employee counts are based on the number of Full-Time Equivalent (FTE) employees in the Sheridan County area (full-time employees=1 FTE; part-time employees=.5 FTE; seasonal=.25 FTE) Full-Time Employees Part-Time Employees Seasonal Employees Billing Preference: ElectronicHard Copy REASON FOR JOINING THE CHAMBER NetworkingExposureSupport CommunityBecome More InvolvedOther Thank you for completing this membership application! A Chamber staff member will be in contact with you within 2 business days. OFFICE USE ONLY Join Date: CC Processed Payment Logged App Rcvd By Revised November 2018