APPLICATION


Please complete all the required items below to apply for membership and enter your payment by credit card or check. Checks are processed electronically, select "Check" below and supply the requested information. If you need further information please contact us. Thank you for your application.

948 Farmington Avenue, West Hartford CT 06107
Tel: (860) 521-2300  Email: info@WHChamber.com

 Membership Type:  *
  WHCC Fee Schedule (pdf)
First Name  *
Last Name  *
Title  *
Company  *
Address  *
City  *
State  *
ZIP  *
Telephone  *
FAX
E-mail
 
Web Site (URL):
(i.e. - www.whchamber.com)
Business Category  *
Description of Services
(55 character max)
  WHCC Fee Schedule (pdf)
Full-Time Employees:  *
Part-Time Employees:

Total Membership Fee:
$ 
  Billing Information    Click to Copy from Above
First Name  *
Last Name  *
Company
Address  *
City  *
State  *
ZIP  *
Telephone  *
E-mail
 
  Payment Method:  *
Social Networks:      
(check all that apply)
Please let us know who referred you to our Chamber:
Referral Name
Referral Company
    
CVV2 Information

The Card Security Code is located on the back of MasterCard, Visa and Discover credit or debit cards and is typically a separate group of 3 digits to the right of the signature strip.

On American Express cards, the Card Security Code is a printed (NOT embossed) group of four digits on the front towards the right.
Check Information

 


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