Membership Application

Please fill out the information below and submit.

Business Name

Street Address

City/Town

State

ZIP

Mailing Address

Phone

Fax

Website

Contact Person

Year Established

Business Category

Number of Employees

Other Employees on Mailing List

Parent Company

President/Owner

Company Designee

Title

Phone

Fax

Human Resources Contact (Name)

Products & Services

Member to Member Discount

Please tell us who referred you to the Chamber

Payment
Please send in check made payable to: Greater Haverhill Chamber of Commerce, 80 Merrimack Street, Haverhill, MA 01830, call 978-373-5663 with credit card information, or make an online payment using PayPal on the Membership Investment page.