Join Chamber

Business Information
Comapny	Required
Mailing Address
City		State	Zip
Phyical Address (If diiferent from mailing address
City		State	Zip
Phone		Fax	Cell
Website
Type of Business (industry)		Number of Employees	Years of Service
Please provide a profile of your companies business services.
Which certification designation do you have?
HUB (State Federal)		NMSDC ( National Minority Suppliaer Development Council)
8(A) (Business Development)		WBE ( Women Business Enterprise)
MBE (Minority Business Enterpris)		SDB (Small Disadvantage Biusiness)
DBE (Disadvantaged Busniess Enerprise)
Is your Business at least 51% African American Owned?
Main Representative Information
Name		Title
Phone		Ext.	Cell
Email		Fax
Additional Representative Information
Additional Rep 1
Name		Title
Phone		Email
Rep 2
Name		Title
Phone		Email
Rep 3
Name		Title
Phone		Email

*All memberships are subject to approval by the Quad County African American Chamber of Commerce Board of Directors.

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