The Executive Board About Us Events Meetings Members
Discount Program Registration Form
Business Name:________________________________________________________________
Contact Person:________________________________________________________________
Mailing Address:_______________________________________________________________
Town:________________________________________________________________________
Telephone:____________________________________________________________________
FAX:__________________________________WEBSITE:_____________________________
EMAIL:______________________________________________________________________
Brief description of business:_____________________________________________________
______________________________________________________________________________
Yes, I would like to participate in the following program:
___ 10% Discount Program
___ Labor/Product discount (please indicate details)
___ Restaurants - free or discounted food (please indicate details)
Details:_______________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
As a community service, we will publish this information on our website for easy reference.
Please return completed form by mail to The Amityville Chamber of Commerce:
PO BOX 885
AMITYVILLE, NY 11701
****PLEASE MAKE COPY FOR YOUR RECORD****