<p>Firm Name ______Date ______</p><p>Address ______</p><p>City ______State ______Zip Code ______</p><p>Mailing address (if different from above address)</p><p>______</p><p>Phone ______Facsimile ______</p><p>E-mail address ______</p><p>Web address ______</p><p>Official Representative and Title ______</p><p>Tell us about your business</p><p>______</p><p>______</p><p>Year business was established ______Number of employees Full Time ______Part Time ______</p><p>Investment Amount $ ______Additional Contribution $ ______</p><p>MAIL TO Macon Area Chamber of Commerce 119 North Rollins, Macon, Missouri 63552 Attention: Sharon Scott</p><p>For more information call 660-385-2811 our fax number is 660-385-6543</p><p>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)</p>