Friday, March 20, 2009

Business Network Action Membership Form

Business Networking Action Meeting
Membership Form

Please Print: _______New or ____Existing Business

Name: ____________________________________________
Address: ___________________________________________

City: ____________________ State: _______ Zip Code: _______


Business Phone: (_____)_____________Business Fax: (____)____

About Your Business
Primary Business Structure: (check all that apply)

_ Sole Proprietorship _ Partnership _Home-Based business _ Commercial

___ Profit Business ____Corporation ____Not-for Profit Corporation

Technical Assistance Service Needed:

___Assume Name Act ___Article of Incorporation ___ Bylaws ____Business License

___E.I.N./SS4 ___501© 3 tax Exempt ___ Grants ___Retailer State No.

___Board Officer Training Other: ________________________

Description of Business Services/Products:_________________________

________________________ ________________
Signature/Title Date:
For more information about the membership and mail address call (773) 287-5543.

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