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Partnership Application
Type of Business ______________________________(i.e. Restaurant, service, etc.) Please check one: _____New
_____Renewal
Business Name: __________________________________________________ Business License #________________
Owner/Manager Name: _____________________________________________________________________________
First
Middle Initial
Last
Title
Business Address:
_______________________________
_______________________________
_______________________________
Business Phone Number
( ____)_____-_________
Mobile Phone Number
( ____)_____-_________
Mailing Address:
_______________________________
_______________________________
Email Address:
Facebook page:
Please indicate how you learned about the BuyRioRancho.com initiative:
I am committed to being actively involved in growing our community via the BuyRioRancho.com events per this signed
document. I would like to become a partner with the Buy Rio Rancho initiative and have filled out this application completely
and accurately. I understand, with my signature & payment below, I am committing to a fee of $300/annually payable as a onetime annual amount OR $25.00 per month ($300/annually) to be automatically collected on a monthly basis on the credit card
indicated below. This fee is non-refundable. Further, I agree that this information will be held on my record for as long as I am
a member in good standing.
Applicant Signature: _______________________________________________________
Please check one: _____Annual Partnership of $300 (one-time annual payment)
Date: ___/___/_____
_____Monthly Partnership of $25/month
Partnerships are confirmed upon receipt of payment & this signed agreement. TOTAL: $300.00/year – Payable $25.00/month. I
understand that this monthly fee of $25.00 will be charged to the below credit card as indicated.
Payment received:
_____Check #______Amount______
Please charge credit card: (please check): ___ Discover
_____Cash
___MC
___Visa
Amount_____
___American Express
Account number:
Exp. Date:
Name on Card:
Mailing address for credit card:
City:
E-mail:
Address:
State:
Signature of card holder:
Zip:
Phone:
Date:
BuyRioRancho.com brought to you in partnership with the
Sandoval County Business Builders Kiwanis & the Rio Rancho Regional Chamber of Commerce
BuyRioRancho.com c/o Rio Rancho Regional Chamber of Commerce
4001 Southern Boulevard, Suite B, Rio Rancho, New Mexico 87124-2069
505-999-1835 (o)
505-892-6157 (f)
Email: [email protected]