Membership Application Form | USVCC

Membership Application

Individual Applicant Information
Business Name*
EIN*
State of Incorporation*
NAICS*
Address
Street Address*
City*
Address*
ZIP / Postal Code
Is your business a non-profit?*
IRS Category*
Please include a copy of the IRS Letter with your application.
Accepted file types: jpg, gif, png, pdf.
Is your business certified VOB or SDVOB?*
What organization certified your business?*
Website? Social Media Presence. Include ID or Page.*
Number of Employees
Estimated Revenues
Individual Applicant Information
First Name*
Middle Initial*
Last Name.*
Are you located in a US Territory?*
Are you located at an APO or FPO address?*
Address
Street Address*
City*
State
Address*
ZIP / Postal Code
Is the above address a work address?*
Phone*
Email
Social Media Presence
LinkedIn
List orgs
Military Service
Are you a veteran of the US military?
Are you a veteran business owner?
Branch
Dates of Service.
Rank at Discharge
Type of Discharge
Have you been awarded a Purple Heart medal?
If other than honorable
If not a military member, are you a family member of a veteran of the US military?
Join a Chamber
Select a chamber to join
Choose Your Membership Level
$249 (1-10 Employees), $349 (11-250 Employees) and $499 (251-1000 Employees).
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge and acknowledge that upon submitting this data, I will be taken to the payment platform to pay the $240 annual membership fee.
I certify that my answers are true and complete to the best of my knowledge and acknowledge that upon submitting this data, I will be taken to the payment platform to pay the $270 annual membership fee.
I certify that my answers are true and complete to the best of my knowledge and acknowledge that upon submitting this data, I will be taken to the payment platform to pay the annual membership fee; $249 (1-10 Employees).
I certify that my answers are true and complete to the best of my knowledge and acknowledge that upon submitting this data, I will be taken to the payment platform to pay the annual membership fee; $349 (11-250 Employees).
I certify that my answers are true and complete to the best of my knowledge and acknowledge that upon submitting this data, I will be taken to the payment platform to pay the annual membership fee; $499 (251-1000 Employees).
Product Name
Price: $240.00
Product Name
Price: $270.00
Product Name
Price: $249.00
Product Name
Price: $349.00
Product Name
Price: $499.00
Credit Card

Card Details

Cardholder Name
Signature*
Date*
Date Format: MM slash DD slash YYYY