Member - GrowthZone - Derby Chamber of Commerce

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category: *

Business Keywords (enter a space between words):

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Social Networking:

Facebook Twitter Instagram

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Membership Options

Membership Package: *

Classic Membership: $325.00
Derby Chamber of Commerce membership for one year. $30 Monthly Payments: $30.00
In order to set-up $30 monthly payments a completed authorization form is required. Chamber staff will be in touch with required form and further instructions. Please select the "bill me" payment option below.

Additional Opportunities:

We will contact you with additional information.

Additional Location : $125.00
May be added to a Classic membership at a reduced rate of $125, allowing the marketing of other locations. Businesses with second locations or branch offices must share common ownership and business category.

Payment Option:

Bill me Charge my credit or debit card

Member Application

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