| Kennett BIZNET Application |
| Name Title Business Name Business Address Business City Business Phone Email Address |
| ________________________________________________________________ |
| ________________________________________________________________ |
| ________________________________________________________________ |
| ________________________________________________________________ |
| ____________________________ State_____________ Zip______________ |
| ____________________________ Cell Phone____________________________ |
| _______________________________@________________________________ |
| Company Profile (Type of Business, Description of Business and Your Duties, Overall Advertisement) |
| Date_________________ |
| ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ |
| Please submit your application form and initiation fee of $75 to Joe Colon (Current Treasurer). There is an annual dues of $25 a year thereafter, plus the cost of breakfast. |
| (Simply print this page and fill out the application) |
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