The Gift Corporation 100 Main Street, Suite D Hempstead, NY  11550 516.483.3300 Fax: 516.483.3313 Email: admin@thegiftsociety.org
Business Name	* required
Business Address1	* required
Business Address2
City	* required
State	* required
ZIP Code	* required
Country (if outside US)
Employer Identification Number (EIN)	* required
Business Telephone	* required
Business email	* required
Date Business Started (MM/DD/YYYY)	* required
Tpye of Business	Choose From Below Service Industry Finance Manufacturing Health Industry Legal Real Estate Telecommunications Information Resources Insurance Transportation Other
Is Your Business/Organization a 501(c)(3)?	Yes No
Primary//First Manager (self)	* required
Secondary/Second Manager
Tertiary/Third Manager
Quatenary/Fourth Manager
If accepted as a member of The Gift Society™, the owner/officer of the business agrees and promises to fulfill the following: 1) to obey all rules and regulations of The Gift Society™ and, 2) to own a computer	Yes No
Name of the person that invited your business/organization	* required
*PLEASE PRINT A HARD COPY OF THIS APPLICATION BEFORE SUBMITTING ELECTRONICALLY BELOW.
Signature_______________________________	Date of Signature___________________________
NOTARIZATION
The individual name on this form has appeared before me in person and acknowledged the due execution of this Business Membership Form.
Printed Name of Notary Public_________________________	Date Commission Expires________________________________
Original Signature of Notary Public_________________________________	Date of Appearance_______________________________
AFFIX NOTARY SEAL

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