Become a Member

*Legal Name of Firm or Individual (required)
(Ex. numbered company, include "Inc." or "Ltd." if applicable):

Marketing Name of Firm

(As you wish for it to appear in the directory):

Which Membership Level would you like to enrol in?View Membership Level Benefits here.
GoldSilverBronze

Physical Address (required)

(This address is used for publication):

City:

Postal Code:

*Mailing Address (required)

(This address is used for publication):

City:

Postal Code:

*Billing Address (required)

(This address is used for publication):

City:

Postal Code:

Phone (required):

Toll Free:

Fax:

Company Email:

Company Website:

*Year Firm Established:

*Number of Employees
Part-time:

Number of Employees
Full-time:

Business Category (required)
(One category listing is standard with membership): AccountantsAssociations, Clubs and OrganizationsAutomobile Body RepairAutomobile, Parts & SuppliesAutomotive Dealers – New, Used & LeaseBeauty-Hairstyling SalonsBookbindingBroadcastingBus LinesButchers & Frozen MeatChiropractorsCleaning Systems –Pressure, ChemicalClothing-Work WearComputersConstruction - ConcreteContractors-GeneralConvenience StoresDairiesDecorating & Home DécorDentistsDistributorEducationElectrical ContractorsFarm RetailFarmingFinancial InstitutionsFinancial ServicesFinishing ShopFlooringFloristsFuneral HomesFurniture & ApplianceGaming EntertainmentGift Stores & CollectiblesGolf CoursesGovernmentHardware, Home & AutoHealth Food & SupplementsHealth and WellnessHeating & CoolingHome AutomationHospitalsHotels/Motels – HospitalityIndustrialInsuranceInternet Service ProviderInvestmentsJewellers - Sales & RepairsLawyersLift Truck Sales & ServiceManufacturingMarine ParksMarketingMassage TherapistMonuments-MemorialsMuseumsOpticiansOptometristsOutdoor Enclosure DistributorPersonalPest ManagementPet Specialty Food & ServicesPharmaciesPhotographyPhysical TherapyPrinters & Copying ServicesReal EstateRecyclingRetailRestaurantsRetirement HomesScreen Printing & EmbroiderySign ManufacturingSmall Business FinancingSpirits-Beer & Ale SalesSwimming PoolsTax ServiceTaxi ServiceTravel AgentTrucking & Transportation ServicesVeterinariansWholesale Industrial EquipmentOther

Representative:
Main Contact: Mr.Mrs.Ms.Dr.

First and Last Name:

Title:

*Email:

How would you like to receive your Chamber correspondence (please check one):
MailEmailBoth

Business Description:
Please provide a brief company description (30 words or less) to be used for Chamber publications when needed.

Note: All above information marked * will not be produced for Wallaceburg & District Chamber of Commerce publications.

We hereby acknowledge we are consenting to the publication of the above provided information, including Business Name, Mailing Address, Fax and Telephone Number, Representative, Business Email and Website, in the Members' Directory, the posting of this information on the Chamber's website and any other similar listing that may be published and distributed in order to assist members and non-members to contact my business. Should you have any concerns regarding your privacy, please contact Administrative Assitance, Tina Fraleigh, at 519-627-1443.
Checking this box acknowledges your consent. Please review our website privacy policy and terms of use for more information.