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Supporting and Promotional Member Application
Email address *
Business Name (or DBA) *
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Business Name (as registered with IRS) *
Your answer
Business Address(es): *
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Mailing Address:
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Business Phone: *
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Hours: *
Please list if open to the public
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Oregon BIN # *
Business must be registered with the State of Oregon.
Your answer
Contact Name: *
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Website: *
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Brief Description of Business
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Primary Products for Sale *
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Certifications
Check all that apply
Number of Employees *
Full-time/30 hrs a week only
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Name of person submitting application *
Your answer
Affiliation with business *
Your answer
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