Lufkin/Angelina County Economic Development Partnership Application

Business

Company Name
Street Address
Street Address 2
City
State
ZIP Code
Phone
Fax
Website
 

Primary Contact (This person will be listed in the Business Directory)

First Name
Last Name
Title
Phone Number
Alternate Telephone Number (cell, etc.)
FAX Number
Email Address
 

Billing Information (If different from Primary Contact)

Name
Title
Street Address
Street Address 2
City
State
ZIP Code
Alternate Telephone Number (cell, etc.)
Email Address
 
 

Payment Info

Card Type
Name on Card
Credit Card Number
Expiration
Amount Due