Member Application Form
Beacon Business Alliance
Applicant Name (please print First and Last)
Business or Organization Name
Primary Business Owner/Director Name (if different)
Address
Mailing Address
Street Address Line 2
City / State
State / Province
Zip
Mobile or Home Phone
Work Phone
Email
example@example.com
URL
Provide a short description of your Business, Service, or Organization for web listing:
Provide your business logo:
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Fees for Commercial/Nonprofit
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( X )
Sustaining Member
$
500.00
Business, 1-5 Full Time Employees
$
50.00
Business, 6-15 FTE
$
100.00
Business, 15 or more FTE
$
200.00
Non Profit, 1-5 FTE
$
30.00
Non Profit, 6 or more FTE
$
100.00
Friend/Supporter
$
30.00
Additional Donation
$
20.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code (incl. the full 9digits)
Questions? (206) 459-1430, info@beaconbusinessalliance.org
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