- Southaven Chamber of Commerce

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words):

Comments / Questions:

Home-Based Business:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Social Networking:

LinkedIn Facebook Twitter Instagram Pinterest Google Plus

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Additional Fees:

Application Fee - New Member : $25.00
Processing fee for new member

Additional Opportunities:

We will contact you with additional information.

Add'l Apartment Unit : $1.00
200 units are included in membership; for all units over 200, charge $1 each Add'l Category Listing : $35.00
One Category Listing is included with each membership. If you wish to be listed under an additional category, choose this option. Add'l Business Location : $40.00
Annual Investment - Same name, different location

Payment Option:

Charge my credit or debit card

Member Application

Mailing Address

Address

Address