Member Application

You're moments away from enjoying the discounts and services provided to member-businesses from the Charleston Area Alliance. Please carefully complete the entire application. This is our reference for getting an updated and useful directory page that will be featured on our website. The more information you provide, the better we are able to drive consumers toward your business. Should you have any questions, please contact Hollis Lewis at 304-340-4253. We look forward to serving you as a member of the Charleston Area Alliance.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Primary Contact Information

First Name: *

Last Name: *

Title: *

Phone: *

Fax:

Email: *

Contact Preference:

Email Phone

Social Networking:

LinkedIn Facebook Twitter YouTube Instagram

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title: *

Phone: *

Fax:

Email: *

Contact Preference:

Email Phone

Social Networking:

LinkedIn Facebook Twitter YouTube Instagram

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Home-Based Business (1 Full Time): $200.00
1 - 5 Full Time Employees: $400.00
6 - 15 Full Time Employees: $500.00
16 -29 Full Time Employees: $700.00
30 - 41 Full Time Employees: $1,000.00
42 - 75 Full Time Employees: $2,500.00
76 - 100+ Full Time Employees: $3,800.00

Payment Option:

Bill me Charge my credit or debit card

Print Application