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.
My Products
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Non-Profit Membership
Membership for one year for Not-for-Profit Organizations with (1) representative

$75.00



Single Membership
For 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



Level 1 Membership
Scrolling Banner, middle page positions, all devices - Logo w/website link

$150.00



Level 2 Membership
Constant Banner on page bottom, all devices - Logo w/website link

$325.00



Total

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

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
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