Company name

Owner/Contact Name

Contact Phone

Business Address

City, State ZIP

Email

Website Link

Facebook Link

Instagram Link

Tik Tok Link

X Link

Business Description

Please provide a brief description of your business:

Logo (please upload your logo)

I am a Non-Profit

Please list my business for free on the general Non-Profit Page

I would like to be listed on the general Non-Profit page AND would like a membership

Please select any categories that is appropriate for your business listing

Other (please write category type)

Service Areas

Please check the areas of Idaho where you will travel to or provide services in:

ALL AREAS

Eastern Idaho Region (Counties: Bingham, Bonneville, Butte, Clark, Fremont, Jefferson, Madison, Teton)

Magic Valley Region (Counties: Camas, Cassia, Gooding, Jerome, Lincoln, Minidoka, Twin Falls)

Northern Idaho Region (Counties: Benewah, Bonner, Boundary, Clearwater, Idaho, Kootenai, Latah, Lewis, Nez Perce, Shoshone)

Southeastern Idaho Region (Counties: Bannock, Bear Lake, Caribou, Franklin, Oneida, Power)

Treasure Valley Region (Counties: Ada, Boise, Canyon, Elmore, Gem, Owyhee, Payette, Washington)

Wood River & Central Mountains Region (Counties: Adams, Blaine, Custer, Lemhi, Valley)

Do you add a travel fee to travel out of your registered area?

Yes

No

Membership

Monthly Membership

$25 per month

Payment Information

PLEASE NOTE, YOUR MEMBERSHIP IS PENDING APPROVAL. UPON APPROVAL, YOU WILL RECEIVE AN EMAIL AND NOTIFICATION OF START DATE. WE WILL NOT CHARGE YOUR CARD BEFORE YOUR OFFICIAL START DATE. PLEASE ALLOW 5-7 BUSINESS DAYS FOR PROCESS.

Billing Address (if different from business address)

Payment Method

Credit Card

Debit Card

Cardholder Name:

Card Number (for office use only)

Expiration Date (for office use only)

CVV (for office use only)

Zip Code (for office use only)

Additional Information

How did you hear about IdaGO Collective?

Terms and Conditions

By submitting this form, you agree to abide by the rules and regulations of IdaGO Collective.

Membership fees are non-refundable.

By submitting this form, you agree to be contacted by IdaGO Collective to obtain any needed additional information before membership start.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

FOR OFFICE USE ONLY

Membership Start Date:

Member ID:

Payment Received

Yes

No

Logo Received

Yes

No