Premier Partners Application - Bartlesville Chamber of Commerce

Company Name

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Fax

Website

Mission Satement

Representative's Information

Primary Representative's Name

First Last

Title

Phone (if different from company number)

Email

Investment Amount

Minimum Dues for Premier Partners* $2,500.00 The investment can be prorated to maintain your current renewal date. Once we receive submission of this form, we will contact you as to your investment amount after it has been prorated.

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Email

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