Macon Area Chamber of Commerce

Firm Name ______Date ______

Address ______

City ______State ______Zip Code ______

Mailing address (if different from above address)

______

Phone ______Facsimile ______

E-mail address ______

Web address ______

Official Representative and Title ______

Tell us about your business

______

Year business was established ______Number of employees Full Time ______Part Time ______

Investment Amount $ ______Additional Contribution $ ______

MAIL TO Macon Area Chamber of Commerce 119 North Rollins, Macon, Missouri 63552 Attention: Sharon Scott

For more information call 660-385-2811 our fax number is 660-385-6543

Your investment to the Macon Area Chamber of Commerce is NOT deductible as a charitable contribution, but it may be deducted as a business expense for Federal Income Tax purposes. (You should always seek advice from your tax consultant)