Application

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Organization Information (to be displayed online)

Organization Name

Address 1

Address 2

City

State

Zip

Phone

Fax

Website

Main Contact

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First Name

Last Name

Address 1

Address 2

City

State

Zip

Title

Phone

Additional Contacts

Contact 1

First Name

Last Name

Title

Email Address

Contact 2

First Name

Last Name

Title

Email Address

Contact 3

First Name

Last Name

Title

Email Address

Contact 4

First Name

Last Name

Title

Email Address

Contact 5

First Name

Last Name

Title

Email Address

Contact 6

First Name

Last Name

Title

Email Address

Contact 7

First Name

Last Name

Title

Email Address

Contact 8

First Name

Last Name

Title

Email Address

Contact 9

First Name

Last Name

Title

Email Address

Contact 10

First Name

Last Name

Title

Email Address

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Billing Address (if different)

Address 1

Address 2

City

State

Zip

Mailing Address (if different)

Address 1

Address 2

City

State

Zip

Additional Information

Referred By

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Business Resources
Community Involvement
Cost Savings Programs
Economic Development
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Training Opportunities
Other

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Primary Directory Category

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Number of Full Time Employees

Number of Part Time Employees

Number of Rooms

Number of Seats

Number of Associates

Number of Locations

Millions in Assets

Annual Membership Investment

Additional Items

Additional Categories Cost

One-Time Application Fee

Tax

Total

Credit Card Information

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Credit Card Type MastercardVisaDiscoverAmex

Credit Card Number

Name on Card
Security Code
Valid Through
Address
City
State
Zip
Phone
Credit Card Email Address

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Community Bankers of Michigan. All Rights Reserved.
830 West Lake Lansing Road, Ste. 250 | East Lansing, MI 48823
Phone: 517.336.4430 | [email protected] | sitemap

Please note that by using some of the links on our pages, you will be leaving Community Bankers of Michigan website. As a service and for informational purposes only, CBM may provide listings of and/or links to third party web pages/publications maintained by the U.S. Government, internet retailers, organizations and others. CBM does not monitor and is not responsible for the content or administration of these outside websites or pages.

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Application