2026 Chamber of Commerce Membership

102 N. Second Street, Suite A Cochran, GA 31014

Phone: (478) 934-2965

info@cochran-bleckley.com

melissa.barker@cochran-bleckley.com

www.cochran-bleckley.com

Name of Business NonProfit or Individual

Primary Contact Name

Title

Business Street Address Include City State and Zip Code

Cell Number

Fax Number

Phone Number

Email Address

example@example.com

Website

Facebook Page

Instagram Page

Number of Employees FullTime - PartTime

Is a state license required for your business

Description of the Business

Preferred Method of Contact

Business Established Date

Date

Billing Information (if different):

Business Contact Name

Title

Mailing Address Include City State and Zip Code

Cell Number

Fax Number

Phone Number

Email Address

example@example.com

Website

102 N. Second Street, Suite A Cochran, GA 31014 Phone: (478) 934-2965 info@cochran-bleckley.com melissa.barker@cochran-bleckley.com. www.cochran-bleckley.com

I grant to Cochran-Bleckley Chamber of Commerce, its representatives and employees the right to take photographs of me and my property in connection with advertising my business, events, promotions, etc.

I authorize Cochran-Bleckley Chamber of Commerce, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree that Cochran-Bleckley Chamber of Commerce may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and

Web content. I have read and understand the above:

Signature

Print name

My Products

Financial InstitutionsAll Banks, Credit Unions and Loan Companies

$800.00 Quantity

Utility CompaniesWater, Electricity, Cable, Gas, etc.

$550.00 Quantity

Professional ServicesPhysicians, dentists, attorneys, accountants, insurance agencies, veterinarians, lending institutions, financials advisors, real estate agents, architects, pest control, HVAC, pharmacies, contractors, healthcare institutions, etc.

$275.00 Quantity

Educational Facilities

$200.00 Quantity

General Business Tier 11-10 Employees

$175.00 Quantity

General Business Tier 211-25 Employees

$225.00 Quantity

General Business Tier 326+ Employees

$275.00 Quantity

Personal Member: Individual

$50.00 Quantity

Personal Members: Couple

$75.00 Quantity

Associations: Civic Clubs, Non-Profits, churches, etc.

$ Free Quantity

Card Processing FeeMandatory for all online purchases.

$5.00 Quantity

Total

$0.00

Credit Card

Amount Paid

VISA

Name on Card

Label

Exp Date

Date

Cochran-Bleckley Chamber of Commerce

MEMBERSHIP APPLICATION 2026

SCHEDULE OF INVESTMENT

Credit Card