Company Information
Company Name:
Address: 
City: 
State: 
Zip: 
Telephone: 
Fax: 
(800): 
Website Address: 
Keywords with which you'd like to associate your website listing: 
Primary Contact
This contact should receive communication on the following: 
(choose all that apply) 
Salutation: 
First Name: 
Last Name: 
Title: 
Address (if different than above): 
City: 
State: 
Zip: 
Telephone: 
Fax: 
E-mail: 
Additional Contact
This contact should receive communication on the following (choose all that apply):
Salutation: 
First Name: 
Last Name: 
Title: 
Address (if different than above): 
City: 
State: 
Zip: 
Telephone: 
Fax: 
E-mail: 
Business Category & Description
Business Category: 
Business Description for Website (125 words or less): 
Annual Membership Investment
Please indicate your NCVC membership status:



Silver Membership level available for $300/year to independently owned and operated small businesses with ONE location and THREE or less full-time employees. To submit for eligibility, contact Balin Ali.

I would like to pay by: 
 
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