2. Business Name*
4. Location Address*
6. Website and/or Facebook*
7. Phone Number*
9. Hours*
11. We are open for:
13. Take out*

    1. Yes
    2. No
14. Restaurant Delivery Service*

    1. Yes
    2. No
15. 3rd Party Delivery Service*

    1. Yes
    2. No
16. Delivery Service

    Check all that apply

    1. DoorDash
    2. Grubhub
    3. Postmates
    4. Uber Eats
    5. Toast TakeOut
18. Dine In*

    1. Yes
    2. No
20. Other Information
22. The following will only be used to verify the submission information.
24. Submitter Name*
26. Submitter Email*
28. Submitter Phone*
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

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