Membership Application
Florida Puerto Rican/Hispanic Chamber of Commerce, Inc. (FPRHCC)
"Bridging the Future of our Business Community."
2293 Aurora Road Melbourne, Florida 32935
Fax 321-775-3996 Cell 321-863-5165 Cell 321-890-5827
Web Site: www.fprhcc.org
Email: info@fprhcc.org
Date *
MM
/
DD
/
YYYY
Company Name *
Company Rep (Mr./Mrs./Ms.) *
Position *
Physical Address *
City, State, Zip *
Mailing Address if different from above
City, State, Zip *
Phone ( ) *
Fax ( )
Email Address *
Web Page Address:
Additional Company Information: Business Category *
Type of Ownership :Check all that apply or type in another option *
Required
Number of Employees / Members *
Description of Services or Products *
Are you willing to offer a discount to FPRHCC Inc. members *
If you are offering a discount, how much?
Minority Business? *
If your business is a Minority Business, are you certified?
Clear selection
Membership Fees and Levels: please choose one: *
Committee and/or committees I wish to serve on (Check all that apply)
Signature (Please type in your first and last name) *
Date *
MM
/
DD
/
YYYY
Referred by:
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.