THANK YOU FOR JOINING!

Pay by Credit Card or PayPal.

Complete the application and then click the “Submit” button to make a secured payment using your credit card or PayPal account. A copy of your completed application and receipt will be emailed to the address on the form.

Company Name:*

Contact Person & Title:*

Address:*

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip Code

Phone:*

Area Code

Phone Number

E-mail:*

Include email address in directory?*

Yes

Website:*

Business Description (up to 80 characters):

The information below will not be released to the public, but it will help PPBIC deliver important information (safety alerts, emergencies, relevant meetings, etc.) to the appropriate people.

Number of Full Time Employees:*

Number of Part Time Employees:

Main Contact Name, Telephone, and Email Address if Different from Above

Facilities Manager Name, Telephone, and Email Address:

HR Manager Name, Telephone, and Email Address:

Membership Type:*

Total:

Verification:

Pay by Check

Click the button below to download the application form. Send that form along with your check to:

Peterson Pulaski Business & Industrial Council
5724 N. Pulaski Road
Chicago, IL 60646

Download Form