Shopping

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					                                                DB Updated: Date: _____________   ID: ____________


                       2011/12
                  FREE Listing Form
                                    Shopping Section
Please fill out and/or update the information below as completely as possible:
Business:                                                                  Year Established in
                                                                           Haldimand County:
Contact Name:                                                   Title:
Mr.  Mrs.  Ms.  Other  ________
Mailing Address:                                                Town:
911 Address (if different):                                     Postal Code:
Town Listed Under:
Highway Access: (ie. Nearby Reg. Rd./Hwy)
Phone:                                Toll-Free:                         Fax:
E-mail:                                      Web Site:
Season (ie. May to September/year round):
Days/Hours:
Wheelchair Access: (full, limited, etc.)

Please answer the following questions with Yes or No
Shopping:                          Specialty Shopping:           Flowers/Gardening items:
Artisan Gallery/Studio:            Visa accepted:                MasterCard Accepted:
American Express accepted:         Debit accepted:               Travellers Cheques accepted:


Other Cards or payment accepted:
Description (25 words FREE, one word per box):




NOTE: If this description exceeds 25 words, it will be edited without your consultation. (Contact
information such as address, phone, e-mail, web address not included in word limit.)

  Please return this form via mail or fax to 905-772-3542 or complete online
                               on or before January 31, 2011
                                           DB Updated: Date: _____________   ID: ____________


                     2011/12
                FREE Listing Form
Please contact me about Advertising Space Opportunities…………………..

I consent to the use and release by Haldimand County of all information contained herein.


___________________________________                           ________________________
Signature                                                     Date




 Please return this form via mail or fax to 905-772-3542 or complete online
                            on or before January 31, 2011

				
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