HACC Member Application
Name:
Phone Number:
Address:
State
Zip
Business Name:
Phone Number:
Business Role:
Preferred Contact Method:
Phone
Text
Business Established Date:
Number of employees:
Ignitor- $225 Catalyst- $500
Membership Level Requested:
Trailblazer- $1,000
What do you want to get out of your HACC membership? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________
Would you like to Schedule a Ribbon Cutting or Grand Opening? (Ribbon Cuttings require a minimum of 3 weeks to plan)
Yes
No
Yes
No
Are there any additional reps you would like to have access to your online portal?
Name
Name
Role:
Role:
Email:
Email:
Office Use:
4
Date
Initials
+256.773.4370
110 Railroad St SW, Hartselle, AL 35640
admin@hartsellechamber.com
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