Lakeville Minnesota Chamber of Commerce Fax Application

Lakeville Minnesota Area Chamber of Commerce

Submit your application by Fax:

Fax the completed form, including payment information, to:
952-469-2028

Firm Name:
Contact Person:
Title:
Other Representatives:



Category of Business:
Street Address:
Suite/Room/Apt.: (if any)
City: State: ZIP:
Phone: Fax:
E-mail: Website:
Year Business Founded: Number of Employees:
Membership Category:
Business Description:
Annual Membership Investment:
One-Time Processing Fee:
Total Investment + Processing Fee:

Type of Credit Card:	Visa MasterCard
Credit Card Number:
Expiration Date:
Name on Credit Card :
Signature:
ZIP Code credit card statements are sent to:
By providing this information, I certify that I understand the appropriate amount will be charged to my credit card based on my selection/s and the information I provide. This Application is intended to be submitted via Fax. It cannot be submitted through this Website. Lakeville Area Chamber of Commerce and Convention & Visitors Bureau 19950 Dodd Boulevard Suite 101 Lakeville, MN 55044 Phone: (952) 469-2020 or (888) 525-3845 Fax: (952) 469-2028 E-mail: info@lakevillechambercvb.org Copyright 1998 - 2011. Lakeville Area Chamber of Commerce. All rights reserved. Hosted and maintained by Minnesota MicroNet