Membership Application Form Perth & District Chamber of Commerce

Business Name*
Phone*
Email*
Address*
Street AddressAddress Line 2CityPostal Code
Fax
Website
Contact Name*
Type of Business and Products / Services provided*
Number of Owners
Number of Employees - Part-Time
Number of Employees - Full-Time
How do you wish to receive information?
- Email
- Fax
- Delivery (only within walking distance of Chamber office)
The above information will be used to promote your business through personal referrals and on the Chamber of Commerce website. As well, the information will be forwarded to TD Canada and Doucett Insurance in order to provide you with information on better bank and insurance rates through the Canadian Chamber of Commerce. A representative from TD Canada will be contacting you. The Chamber will not use personal information for any purpose other than that for which you have consented. It shall be kept confidential and for the exclusive use of the Perth and District Chamber of Commerce and the above mentioned authorities.
*
- Please check here if you agree with the above statement
- Please check if you do not want any information forwarded to TD Canada or Doucett INsurance
- Check here to accept membership agreement.
Please make payment by cheque and send to the Perth & Diistrict Chamber of Commerce.

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