Tipp City Chamber of Commerce Application A Minimalist, Solid Black Vertical Banner. Facebook-f Instagram Linkedin-in Tiktok To view this form, please enable JavaScript in your browser. Organization Information (to be displayed online) Member Business Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Address 1 Required Please enter a valid number Please enter a valid date Please enter valid credit card information Address 2 Required Please enter a valid number Please enter a valid date Please enter valid credit card information City Required Please enter a valid number Please enter a valid date Please enter valid credit card information State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Required Please enter a valid number Please enter a valid date Please enter valid credit card information Phone Required Please enter a valid number Please enter a valid date Please enter valid credit card information Fax Required Please enter a valid number Please enter a valid date Please enter valid credit card information Website Required Please enter a valid number Please enter a valid date Please enter valid credit card information Email Required Please enter a valid number Please enter a valid date Please enter valid credit card information Must be a valid email address Contact First Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Contact Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Cell Phone Required Please enter a valid number Please enter a valid date Please enter valid credit card information Year Business Started Required Please enter a valid number Please enter a valid date Please enter valid credit card information Company Description Required Please enter a valid number Please enter a valid date Please enter valid credit card information Membership Investment Membership Type Select One... Standard Membership (Price per employee) Non Profit/Charitable Organization Retired Individual Government/Educational Utility Companies Financial Institutions Commercial Developer/Builder Platinum Investor Gold Investor Primary Directory Category None Accountants/Tax Services Agriculture Apartments Art Gallery & Sales Attorneys Auto Parts & Accessories Auto Rental Auto Sales Auto Service & Repair Awards/Trophies Bakery/Confections/Coffee Shop Banks & Credit Unions Bars Business Services Cabinetry Catering/Banquet Facilities Childcare / Child Services Churches Cleaning/Janitorial Commercial Developer / Builder Community Business Computer Computer Service & Repair Construction Construction Consultants Construction Contractors Contractors Convenience Store/Gasoline Dentists/Orthodontists Dry Cleaning Education Education Services Employment Services Enviromental Event/Sport Facility Financial Services Fitness Centers/Health Clubs/Gyms Florist Funeral Services Gift Shops Golf Carts Golf Courses/Driving Ranges Government Services Graphic Design/Marketing/Advertising/Web Hair Salon / Barber Shop Health/Wellness Healthcare Heating & Air Conditioning Hobby Shop Home Improvement Hotels/Motels Insurance Insurance (Business) Insurance (Health) Interior Design Internet Technology Landscaping Machine Shop Manufacturing Media Services Medical Services/Doctors Mobile Sanitation Monuments Office Supplies/Print Services Pest Control Pet Grooming & Products Pharmacy Photography Real Estate Realtor Lessors Rehabilitation Rentals - Equipment, Party, Other Residential Builder Restaurant Restoration Retail Retired Retirement/Assisted Living/Nursing Home Services Signs Storage Facility Tattoo Shop Telecommunications Title Agency Transportation Services Utilities Veterinarians Website Development Workers' Compensation 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 Required Please enter a valid number Please enter a valid date Please enter valid credit card information Part-Time Employees Required Please enter a valid number Please enter a valid date Please enter valid credit card information Hotel/Motel Rooms Required Please enter a valid number Please enter a valid date Please enter valid credit card information Restaurant Seats Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Associates Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Associates Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Locations Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Locations Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Assets Required Please enter a valid number Please enter a valid date Please enter valid credit card information Assets Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Categories Required Please enter a valid number Please enter a valid date Please enter valid credit card information Number Of Additional Categories Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Categories Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 1 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 2 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 3 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 4 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 5 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 6 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 7 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 8 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 9 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 10 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Annual Dues (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information Revenue Item Required Please enter a valid number Please enter a valid date Please enter valid credit card information Tax (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information Fee (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information Temp Value For DropDown 1 Required Please enter a valid number Please enter a valid date Please enter valid credit card information MembershipType Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 1 Additional Item 2 Additional Item 3 Additional Item 4 Additional Item 5 Additional Item 6 Additional Item 7 Additional Item 8 Additional Item 9 Additional Item 10 Payment Type Credit Card Check NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks. Additional Directory Categories Select additional directory categories below by holding the "CTRL" key Secondary categories may be subject to additional fees none Number of Rooms Number of Seats Number of Associates Number of Locations Millions in Assets Annual Membership Investment Additional Items Additional Categories Cost One-Time Application Fee Tax Credit Card Information Copy from Organization Information Credit Card Type MastercardVisaDiscoverAmex Credit Card Number Required Please enter a valid number Please enter a valid date Please enter valid credit card information Name on Card Required Security Code Required Valid Through 01 02 03 04 05 06 07 08 09 10 11 12 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 Address Required City Required State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Required Phone Required Credit Card Email Address Please click submit only one time. The transaction may take several seconds. Please select a membership type before submitting your application.