Online Application Form

Please complete all the information below.

Please note: Although it is most unlikely that you will experience any problems responding to this form, certain non-standard browsers will not respond properly. If you experience any difficulties, (or if you are not using a forms-capable browser) you may print this form and fax it to (512) 756-2548.

* Required Information

* Company Name:

* Type of Organization:

	Individual/Family/NonProfit	$45
	Financial/Utility	$300
	Industrial/Manufacturing/Construction	$250
	General Business 0-15 Employees	$150
	General Business 16-30 Employees	$200
	General Business 31-40 Employees	$250
	General Business 41+ Employees	$300

* Preferred Payment Schedule:
(Option available only after first year)

Annually
Semi-annually
Quarterly

* Primary Category of Business:
(Please select one)

Secondary Category of Business:
(Please select one)

Website Address:

* E-Mail:

PRIMARY CONTACT

* Contact Person First Name:

* Contact Person Last Name:

* Daytime Phone:

Evening Phone:

Cellular Phone:

Pager Number:

E-Mail:
(if different)

PRIMARY LOCATION (Required)

PHYSICAL ADDRESS
* Street Name:

* City:

* State:

* Zip Code:

MAILING ADDRESS (if different than above)
Street Name:

City:

State:

Zip Code:

Toll Free Phone:

Business Phone:

Business Fax:

E-Mail:

# of Employees:

SECONDARY LOCATION (If applicable)

PHYSICAL ADDRESS
Street Name:

City:

State:

Zip Code:

MAILING ADDRESS (if different from above)
Street Name:

City::

State:

Zip Code:

Toll Free Phone:

Business Phone:

Business Fax:

E-Mail:

# of Employees:

BUSINESS INFORMATION

Business Hours:

Please Describe your Products or Services for referrals:

If Hotel/Lodging

Number of Rooms:

Regular Rates:

Seasonal Rates:

What is your Business Slogan? (if any)

What is most interesting about your business?

What do you see as the most important issues facing our area?

How can the Chamber help you?

Which of the following events can you help with during the year? (check all that apply)

Name of Event	Make Donation	Donate Door Prize	Volunteer to Help
Annual Banquet
Bluebonnet Festival
Christmas on the Square
Business Appreciation Cookout
New Teacher Luncheon
Job Fair/Career Days
Chamber Mixers
Train Depot on Weekends

By submitting this form, I hereby make application for membership in the Burnet Chamber of Commerce, Inc. and, if elected, will abide by the By-laws as they are now constituted, or as they may be hereafter amended, support its objectives and interests, and pay annual dues as set by the Board of Directors.