Member - Member Information Center | Greater Fort Wayne Inc.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website: *

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Referred By:

Date Company Established: *

Underrepresented minority-owned business:

Woman-owned business:

Veteran-owned business:

Is your company less than three years old?: *

Is your company a nonprofit organization?: *

Is your company a member of another chamber of commerce?: *

If yes, which?:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Social Networking:

LinkedIn Facebook Instagram Twitter

Primary Contact Information

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Email: *

Contact Preference:

Email Phone

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Email: *

Contact Preference:

Email Phone

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Investment Level 1: $400.00
2-10 Employees Investment Level 2: $600.00
11 -20 Employees Investment Level 3: $800.00
21-50 Employees Investment Level 4: $1,000.00
51-100 Employees Investment Level 5: $2,500.00
101-150 Employees Investment Level 6: $5,000.00
151+ Employees

Additional Opportunities:

We will contact you with additional information.

KPC Business Weekly: $0 : $0.00
I do wish to receive a free subscription to the Greater Fort Wayne Business Weekly paper, (valued at $52) and a free copy of the annual "Book of Lists" (valued at $49.)

Payment Option:

Bill me Charge my credit or debit card

Print Application

Member Application

Mailing Address

Address

Address