Member - The Fairfield Chamber of Commerce

Business Information

Company Name: *

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Phone: *

Website:

Email: *

Business Description (200 char max):

Directory Category:

Employees: *

Full-time Part-time

Business Keywords (enter a space between words):

Comments / Questions:

How did you hear about the Chamber of Commerce?: *

Family-Owned Business:

Year Established:

Non-Profit Tax Status: Is business a 501(c)(3)?: *

Physical Address

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Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

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Line 2:

City:

State:

Postal Code:

Country:

Social Networking:

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Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook Twitter

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook Twitter

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Additional Fees:

One-Time Processing Fee : $35.00
Administration Processing for New Members

Additional Opportunities:

We will contact you with additional information.

Technology Contribution : $0.00
Voluntary contribution to maintain cutting edge technology services.

Payment Option:

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203.255.1011

203.255.1011

Fairfield Chamber of Commerce

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203.255.1011

203.255.1011

Member Application

Mailing Address

Address

Address

Fairfield Chamber of Commerce

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