Covert Membership Payment Form

Date

MonthDayYear
How To Use This Form
1. Fill out the contact info to simply get in touch with us.
2. Choose and purchase a Membership Plan right from the form.
3. Choose to pay for a Sponsorship right from the form.
Company Name*
Contact Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
E-mail*
example@example.com
Website*
Additional Info
The totals below include credit card processing fees.
Subscriptions
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Non-Profit MembershipMembership for one year for Not-for-Profit Organizations with (1) representative
$75.00 for each year



Single MembershipFor businesses with one (1) representative• Features your business on the Chamber’s website• Features your business on Covert Avenue Chamber of Commerce Instagram platform and Facebook platform
$150.00 for each year



Level 1 MembershipScrolling Banner, middle page positions, all devices - Logo w/website link
$150.00 for each year



Level 2 MembershipConstant Banner on page bottom, all devices - Logo w/website link
$325.00 for each year



Total

$0.00
After choosing your Membership, click the "Submit" button below.
You will then be taken to PayPal to finish your subscription payment.
Should be Empty: