Legal Business Name or Individual Name:
Owners:
(Business) Mailing Address:
City:
State:
Zip:
Physical Business Address (if different):
Business Telephone:
Business Fax:
Number of Employees-Kaufman County:
Business E-Mail Address:
Web Site Address:

Local Contact Persons & Title 
(if different from owner):



FOR LODGING MEMBERS, Please give the guest                      
 capacity of your facility: 

Please give a brief description or list a few phrases that describe your business 
(25 words max): 


(If Mailed) Total Amount Attached:

Form of Payment : Check   Visa   Master Card   American Express
($25 fee for returned checks)                                                                         

Account Number:
Expiration Date:

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