Business Network Action Membership Form

Business Networking Action Meeting

Membership Form

Please Print: _______New or ____Existing Business

Name: ____________________________________________

Address: ___________________________________________

City: ____________________ State: _______ Zip Code: _______

Email:______________________________________________

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 email to pffcsg.@aol.com.