Haxtun Chamber of Commerce Membership
Online Investment Statement
Business Membership Information
Full Name of Business or Individual:
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Contact Person:
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EIN or 501(c)3 Tax ID #:
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Mailing Address:
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City:
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State:
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Zip:
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Physical Address (if different than above):
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Physical City (if different than above):
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Physical State (if different than above):
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Physical Zip (if different than above):
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Phone Number:
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Website (if applicable):
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Email:
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Would you like for your e-mail address to be added to our database?
Payment
Commercial Dues Structure - Base Membership:
1-2 Employees: $100.00
3-5 Employees: $150.00
6-10 Employees: $300.00
11-15 Employees: $500.00
16+ Employees: $1000.00

Non-Profit Dues Structure - Base Membership:
No employees: $50.00
1-5 Employees: $75.00
6+ Employees: $100.00

Community Service Membership Dues Structure
Base Membership: $50.00

Individual Member Dues Structure
Base Membership: $30.00

Please mail in your Membership Payment via check or call with your credit card.
P.O. Box 535 Haxtun, CO 80731
Phone: (970) 467-0194

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