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Amery Featured Business Form Request

2. Business Name*

3. Proprietor*

5. Address1*

7. Address2

9. City*

10. State*

11. Zip*

13. Phone Number

14. Fax Number*

16. Business Logo*

    Please send as a png or jpeg file

17. Type of Business*

    1. Retail
    2. Services
    3. Dining
    4. Arts

    1. Entertainment
    2. Health & Wellness
    3. Industry
    4. Lodging/Accommodations

19. Photos for Website Regarding Business

    Please send as jpeg or png file

21. Information Regarding Business for Website

    1 - 2 paragraphs if possible detailing information regarding your business

23. Name of Person Entering Information*

25. Phone Number of Person Entering Information*

26. Email Address of Person Entering Information*

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field