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Company Name
Contact Name
Business Address
City, State & Zip Code
Phone Number (no dashes or spaces)
Mobile Number (no dashes or spaces)
Fax Number
Email Address
Website Address
Number of Full-time Employees
Business Category (Please select from the categories already established in our directory)
Tax ID #
Company Established Since
(Note: Information filled out in this section will be published in the Chamber’s “Business” section of the Beaver County Times.)
Please provide a brief description of what your business does / What makes your business different?
Primary Reasons for Joining the Chamber
Referred By
Facebook Business Name
Twitter Business Name
Date (please enter dd/mm/yyyy)