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Please provide us with your information in the form below. Your application will be forwarded to our Membership Committee and we'll be in touch with you shortly to let you know your application has been accepted. In the meantime if you have any questions please call us at 860.693.0405 or email info@cantonchamberofcommerce.com. Thank you. |
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Member Application: |
| * Company Name: |
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| * Phone: |
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| Website: |
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| * Email: |
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| Business Description (200 char max) |
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| * Physical Address: |
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| * City/State/Zip: |
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| Country: |
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| Mailing Address: |
Same as physical address
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| City/State/Zip: |
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| Country: |
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| Business Category: |
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| Employees: |
Full-time:
Part-time:
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| Comments/Questions: |
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Primary Contact Information: |
| * Name (First / Last): |
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| * Title: |
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| * Phone: |
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| Cell Phone: |
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| Fax: |
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| * Email: |
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| Contact Preference: |
Email
Phone
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| Social Networking: |
LinkedIn: |
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Facebook: |
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| Address: |
Same as Company Address
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| City/State/Zip: |
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| Country: |
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Billing Contact Information: |
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Same as Primary Contact
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| Name (First / Last): |
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| Title: |
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| Phone: |
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| Cell Phone: |
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| Fax: |
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| Email: |
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| Contact Preference: |
Email
Phone
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| Social Networking: |
LinkedIn: |
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Facebook: |
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| Address: |
Same as Company Address
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| City/State/Zip: |
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| Country: |
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| Membership Package: |
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| Additional Opportunities: |
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We will contact you with additional information. |
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| Payment Option: |
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Bill me Charge my credit card |
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| Submit Application: |
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Enter the CAPTCHA words, then press the Submit Application button.
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Submit Application
Print Application
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