Pleasantville Chamber Membership Renewal Form

This application is for current members who would like to renew their Chamber membership.

Business Organization *

Business Type (i.e.: Accountant, Retail, Restaurant) *

Primary Contact *

Address * Street Address Address Line 2

State / Province / Region City

Postal / Zip Code Country

Phone Number * - -
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Fax - -
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Email *

Web Site *

Membership Type: (subject to Review by Chamber Staff) *
Standard Membership: $150/year
Business With Over 15 Employees: $225/year
Non-Profit Organizations and Civic Members: $50/year
Non-Profit Organizations With Over 15 Employees: $125/year
Second business under same ownership: $50/year

*For Members with two businesses, the Chamber offers membership for the second business for $50. Complete a form for each business and mail with a check covering the two.

Payment Information

Cardholder First Name*:

Cardholder Last Name*:

Cardholder Street Address*:

Cardholder Address Line 2:

Cardholder City*:

Cardholder
State / Province / Region*:

Cardholder
Postal / Zip Code*:

Cardholder Country*:

Card Type*:

Card Number*

Expiration Date* / mm/yyyy

Card Code* (CVV)

* required field