EmailMeForm
FCHCC Member Discounts Program Application
CONTACT INFORMATION
Your Business Name:
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This should be the name of the company offering the discount.
Address Information:
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Contact Name:
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Job Title:
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Phone Number:
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Alternative Phone Number: (i.e., cell phone)
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Email Address (must be a working email):
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Retype Email Address:
Website URL:
YOUR MEMBER DISCOUNT:
Describe your Member Discount.
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Estimated Value to Members:
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Who should the member contact with any questions? (please include phone # and email if different from the contact person above.)
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PROVIDE YOUR COMPANY LOGO OR GRAPHIC IMAGE:
Please upload your business logo or your discount graphic ad. (Must be a .JPG, .GIF, or .PNG only.)
Add File
You can upload more than one image.
IMPORTANT:
*Your Member Discount will expire one (1) year after its activation. Chamber staff will contact you when your benefit is due to expire. If you’d like to continue to offer your Discount, please renew it at the time of its expiration.
**DISCLAIMER: The companies that are listed on our website have volunteered to offer discounts to other Chamber members. These discounts are not officially endorsed by the Chamber. Please keep track of how often your discount is used and notify us of any changes to your discount so that we can reflect that on our website. Contact us if any problems arise from your discount. The Chamber reserves the right to disapprove any Member discount if it's not applicable to our members.
AUTHORIZATION:
I hereby certify that I am authorized by my company to offer this benefit to the First Coast Hispanic Chamber of Commerce. Also, that I have provided accurate information about my company benefit in this application.
Do you agree with these terms and conditions?
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Yes, I agree.
Today's Date:
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MM
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Applicant's Initials below:
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