Member - LACCC

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:

DATE ESTABLISHED: *

AREAS COVERED: *

Gross Annual Sales: *

Minority Certified: *

Name Minority Certifications, if any?:

LATINO OWNED: *

Country of Origin: *

Referred by: *

SPANISH SPEAKING: *

Gender: *

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: *

Phone: *

Cell Phone:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

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: *

Phone: *

Cell Phone:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

INDIVIDUAL: $100.00
Individual Membership for Students & Job Seekers GRASSROOT NON-PROFIT: $200.00
Non-Profit (1-5 Employees) LARGE NON-PROFIT: $500.00
Non-Profit (6+ Employees) GOVERNMENT: $1,000.00
Government Departments & Agencies MICRO BUSINESS: $200.00
Micro Business (1-5 Employees or Self-Employed) SMALL BUSINESS: $350.00
Small Business (6-15 Employees) MEDIUM BUSINESS: $500.00
Medium Business (16-25 Employees) LARGE BUSINESS: $750.00
Large Company (26-50 Employees) CORPORATE BUSINESS: $1,500.00
Corporation (50+ Employees)

Payment Option:

Charge my credit or debit card

Member Application

Sitemap

Proud Member