Putnam County Business Council Membership Application

What is your name? *

Best contact number *

Email *

Best contact person (if different)

Contact person’s email (if different)

Contact person’s mobile (if different)

In a sentence or two, what are the single biggest reasons you want to join?

Street address of business *

City *

State & ZIP *

Mailing address if different than above

List address in membership directories? YesNo

Website of business

5 keywords of categories of the business/organization

Operated from your home? yesno

Number employed

Years in business

Type of business entity LLCSole PropS-CorpC-Corpother

How did you learn about us? * Social media postsnewspaper articlesKnown about us for yearsSomeone askedBoard member asked

IF someone referred you, what is their name?

Is there anything you‘d like us to know about you, your business, and why you’re here that we don’t already know? *

4 + 0 = ?Please prove that you are human by solving the equation *