Haxtun Chamber of Commerce Membership
Online Investment Statement
Business Membership Information
Full Name of Business or Individual: *
Your answer
Contact Person: *
Your answer
EIN or 501(c)3 Tax ID #: *
Your answer
Mailing Address: *
Your answer
City: *
Your answer
State: *
Your answer
Zip: *
Your answer
Physical Address (if different than above):
Your answer
Physical City (if different than above):
Your answer
Physical State (if different than above):
Your answer
Physical Zip (if different than above):
Your answer
Phone Number: *
Your answer
Website (if applicable):
Your answer
Your answer
Would you like for your e-mail address to be added to our database? *
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

Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms