Warsaw Business Club Membership Application

Warsaw Business Club Membership Application	Date/Time
	2/5/2012 12:22:35 PM

Applicant's name:

Title / Position:

Company name:

Address:

City:

Province:

Postal Code:

Tel. (Business):

()

Fax (Business):

()

E-mail (Business):

Website (Business):

Tel. (Home):

()

Fax (Home):

()

E-mail (Home):

Company profile:

Description of products / services:

Other trading or corporate names under which this company operates:

Credit Union
Account Number:

Annual membership fee: $ 500.00. Tax deductible business expense. Membership renewable annually on anniversary of your first cheque.

I hereby authorize the St. Stanislaus - St. Casimir's Polish Parishes Credit Union Limited to debit my account for payment of my annual membership dues and any future expenses which I may owe to the Warsaw Business Club.

In the event I should cancel my membership in the Warsaw Business Club, the Credit Union may debit my account for all amounts owing to the Warsaw Business Club.

I also authorize the Warsaw Business Club to publish my membership information in the Club's Membership Directory.

Authorized Signature:
By checking the Authorized Signature Box, you indicate that you have read, understood and agreed to the above statements.

	Warsaw Business Club
	A division of St. Stanislaus - St. Casimir's Polish Parishes Credit Union Limited