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General Information:  
Company Name: A value is required.
Address:
Suite #:
City:
State:
Zip Code:
Country:
Telephone:
Fax:
Cell:
Website:
Email: A value is required.Invalid format.

Contact Information:  
Primary Contact:
Title:
(P)
(F)
(C)
Email:
Preferred Communication Method:
(E)
 
(F)  
Address:
Suite #:
City:
State:
Zip Code:
Country:

Billing Contact:  
Primary Contact: A value is required.
Title:
(P)
(F)
(C)
Email: A value is required.Invalid format.
Preferred Communication Method:
(E)
 
(F)  
Address:
Suite #:
City:
State:
Zip Code:
Country:

Additional Contact:  
Primary Contact:
Title:
(P)
(F)
(C)

Email:

Preferred Communication Method:
(E)
 
(F)  
Address:
Suite #:
City:
State:
Zip Code:
Country:

MEMBERSHIP CATEGORIES
Platinum $2,500 5 Corporate Representatives
Gold $1,500 4 Business Representatives
Silver $1,000 3 Business Representatives
Bronze $500 2 Representatives
International $200 1 Representative
Single $100 1 Representative
Student $25/year 1 Representative
Non-Profit $100/year 1 Representative

BI-NATIONAL CHAMBERS OF COMMERCE COMMITTEES
* Additional to GHCC membership fee listed above
Argentinean-American $25 1 Representative
Dominican-American $25 1 Representative
Ecuadorian-American $25 1 Representative
Guatemalan-American $25 1 Representative
Peruvian-American $25 1 Representative

Is this a Hispanic owned business? Yes No

What is the size of your business?
1-10 Employees
11-25 Employees
26-50 Employees
51-100 Employees
100+Employees

What is the annual gross revenue of your business?
0 to $250,000
$250,001 – $500,000
$500,001 - $1 Million
$1-$10 Million $10-$50 Million
$50+ Million

What is your business industry NAICS / SIC code?
NAICS:
SIC:
www.naics.com / www.osha.gov/pls/imis/sicsearch.html

In your industry, are you considered a:
Small Business Medium Size Business Large Corporation

Do you conduct business outside of the U.S.? Yes No
If ‘yes’, where?

Does your business have certifications? Yes No
If ‘yes’, select certification type and list certifying agency (i.e. City of Atlanta, SBA, MBDC, MARTA)
MBE:
WBE:
DBE:
HBE:
Other:

When was your business established?
1 year or less 2-4 years 5-10 years 10+ years

Do you belong to one of the following Bi-National Chambers of Commerce?
* If interested in joining, please see “Bi-National Chambers of Commerce Committees” above.
Argentinean-American
Dominican-American
Ecuadorian-American
Guatemalan-American
Peruvian-American

Referred by:

  

 
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