NAME:_____________________________________________________ Home Phone:_________________
Residency Address
_________________________________________
City:______________________________
Zip:______________
Business Name: CATEGORY:
___________________
Your Business
Title:___________________________________
Business
Address:
City: STATE:
Florida ZIP:
Business Licenses
with numbers:_____________________________________________________________
Business
Phone: Fax
Email:
Home Page:
_________________________________________________
List all of the
services and/or products your business provides in descending order of
importance.
Length of time in
current business:___________________________________________________________
List all
organizations, groups, clubs professional affiliations and Chamber of Commerce
which your business belongs:
References:
1.____________________________________Title:_______________________Phone:_________________
2.____________________________________Title:_______________________Phone:_________________
3.____________________________________Title:_______________________Phone:_________________
Sponsored by:
I hereby
certify that I/the above referenced business, is neither, a member, and/or
attends meetings of any other business/network/referral group, excluding any
Chamber of Commerce. I acknowledge that
it is prohibited to be a
member and/or attend meetings of any other business/network/referral group,
excluding any Chamber of Commerce while being a member of INTERBUSINESS
RESOURCES, INC. Upon acceptance of this
Membership Application, I agree to read, and be bound by the By-Laws of
INTERBUSINESS RESOURCES, INC.
I further
certify that the above information is true and correct, and hereby submit
my non-refundable (refundable if Application is denied by the Board of Directors)
$100.00 application fee with this Membership Application.
Signature________________________________Date:___________________________________________
Revised: 19-Dec-2006
Please enclose your initial check for $135.00 [$100.00 application fee and $35.00 first months dues] made payable to The Resource Network Group and attach a copy of your business card.