Monthly Direct Payment Application

Thank you for your interest in the Gilbert Chamber of Commerce!

Please complete the following application form. To view our membership levels click here. If you have any questions or need more information please feel free to contact us at info@gilbertchamber.com or call us at (480) 892-0056.

To make a one time annual payment Click Here for the application

Join Now Application w/ACH

Company Name *
Home-Based Business
Website
Address for Online & Print Directory
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Primary Contact
Send primary contact all Chamber Communication
yes
Contact Name * First Last
Title
Email *
Contact Phone * - ### - ### ####
Secondary Contact
Send secondary contact all Chamber Communication
yes
Contact Name First Last
Title
Email
Phone - ### - ### ####
Billing Address
Same as above
Billing Address
If different from above
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Mailing Address
Same as above
Mailing Address
If different from above
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Number of Full-Time Employees
Number of Part-Time Employees
Categories
Primary Category *
If other:
Secondary Category
For Corporate & Premier members only
If other, secondary:
Membership Level *
Entreprenuer ($295) Business ($445) Corporate ($745) Premier ($2995)
Additional Opportunities
Tourism Listing ($180) Medical Listing ($180) Multi-Business ($200)
Marketing Options
Second Category ($50) 25-Word Description ($150) Web Banner ($250)
Payment Option *
Visa Master Discover Amex
Leadership Opportunities
Please select all that apply:
Ambassadors Committee Insurance Benefits Committee Leads Club Public Policy Committee Safety Committee Small Business Council Special Events Planning
I understand two more windows will appear for me to complete the ACH agreement followed by the payment page. All three must be filled out to qualify for the monthly direct payment option. *
Yes
Would you like to receive communication?

119 North Gilbert Road, Ste 101 • P.O. Box 527 • Gilbert, AZ 85299-0527 | Phone: (480) 892-0056 | Fax: (480) 892-1980
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Join Now Application w/ACH

Join Now Application w/ACH

Primary Contact

Secondary Contact

Categories