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Membership Application

Minden-South Webster Chamber of Commerce
110 Sibley Road
Minden, Louisiana 71055


318.377.4240
318.377.4215 fax

 

Office Hours: M-TH 8:00 AM to 5:00 PM
Friday 8:00AM to 12:00 PM

Name of Business:

Date Established:

Type of Business:

Physical Address:

Mailing Address:

City:

State:

Zip:

Business Telephone:

Business Fax:

Business Cell Phone:

Business Owner's Name:

Website:

Primary Business Contact:

Primary Contact's email:

Business email 1:

Business email 2:

Business email 3:

Best Contact Method:

   phone   email   mail   fax

Schedule of dues:

Number of employees:

Signature of Applicant
NOTE: Membership is valid for one calendar year from the date this application is signed.

Business Representaive Signature:

Signature Date: