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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