Online Membership Application Form

Please complete all fields.
Company Name:
Contact Person:
Position:
Postal Address:
Street Address:
Telephone:
Facsimile:
Mobile:
Email:
Website Address:

Tick the one section relating to your business:

Persons Engaged
in Enterprise		 Annual Subs Monthly
Payment
Direct credit only
Start-up - New business trading less than 12 months  $120.00  
65+ Individual M/ship for retired business people $50.00pp  
1 - 3 full time staff $185.00 $17.00
4 - 6 full time staff $280.00 $25.00
7 - 9 full time staff $390.00 $35.00
10 - 50 full time staff $560.00 $51.00
51+ - $560 + $10 for each staff member up to maximum of $820
 Note: All fees include GST
Actual number of Full
Time Equivalent Staff:
Exporter:   Yes   No

Business Description:

This Information will be Submitted to our Online membership Database 
at www.northchamber.co.nz Please make it 30 words or less.

 
Please forward a 200 word profile of your business to info@northchamber.co.nz
which will be advertised in our next e-News letter.

Business Categories:
Category 1 
Category 2 
Referred by: Select ONE of the following:
Website Events  
Email  
Word of Mouth  
Other (please advise)  
Chamber member (please advise name of business)  

Payment Details:

  Cheque
Make payable to : Northland Chamber of Commerce
  Direct Credit: Full subscription
Northland Chamber of Commerce
Westpac 03 0497 0322266 00
  Direct Credit: Monthly payment
Northland Chamber of Commerce
Westpac 03 0497 0322266 00
Date: