Online Membership Application

 
Application is hereby made for membership in the Greater Lafayette Commerce to help underwrite the business growth and civic improvements of the Greater Lafayette area. When membership investment is current, membership is continuous until written resignation is submitted.
   
Company Information
Company Name *
Address 1 *
Address 2
City *
State *
Zip *
Phone *
Fax
Website
Email *
Main Contact
First Name *
Last Name *
Title
Phone *
Email *
Additional Information
Reason for Joining *
Business Classification *
Date Firm Established *
Membership Investment
Membership Type: *
Please choose your required level of dues from our Annual Dues page (will open in new tab/window).
Number of Full Time Employees:  
Number of Part Time Employees:  
   
Total: $ 

The contents of this box are for testing purposes. This box will be removed when the form goes live.
Full-Time Employees
Part-Time Employees
Annual Dues (charged to card)
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Credit Card Information
Credit Card Type *
Credit Card Number * 
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Please click submit only one time.  The transaction may take several seconds.


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