DACC Membership Application

Durant Area Chamber of Commerce

215 N 4th Ave

Durant OK 74701

durantchamber.org

(580) 924-0848
Membership Application
Business Name*
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number To Be Listed*
E-mail*
example@example.com
Are you interested in serving on any Chamber committees?*

YesNo
Website
Brief description of product or service*
Please choose a category that best describes your business*
Annual Investment Schedule*

1-5 Employees........Annual $2006-10 Employees........Annual $24511-20 Employees........Annual $35021-50 Employees........Annual $47551-100 Employees........Annual $750100+ Employees........Annual $760 (Plus $2 of each additional employee)Motels/Hotels/Lodging....Annual $200 (Plus $1 per unit)Insurance/Real Estate Agencies......Annual $200 (Plus $25 per associate)Banks & Financial Institutions ($36.00 per million dollars of deposits as of June 30 each year)Clubs/Organizations......Annual $80Individual (Employed) $80Individual (Retired) $60
How many employees?*
I acknowledge that I will be invoiced online*

YesNo
Name of Authorized Representative Submitting Form:*
Date*

MonthDayYear
Date
Should be Empty: