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Plaque or Date Plate Request Form

Please fill out this form to request a new plaque or date plate for your chamber plaque.

This form is used to request a date plate or plaque from the Tecumseh Chamber of Commerce for display in your organization. Please use this form to request your plaque or date plate/s. After completion, please allow 72 hours for a chamber representative or staff member to contact you regarding your request.

Organization Mailing Address
Person Filling Out This Form
Phone Number
Email
Our organization needs a new chamber plaque.
Our organization needs a date plate.
Our organization needs date plates for the year/s:

Please enter all years missing.

Follow Up:

A staff member of the chamber or volunteer/TAG member will reach out shortly regarding your request. We appreciate you taking the time to contact us today.

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