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2. Business name*
3. Account number*
5. Would you like your business displayed in the business directory?*

   1. Yes

   1. No
7. Please indicate the information you would like displayed in the online buisness directory:

   Check all that apply:

   1. business address
   2. mailing address
   3. phone number
   4. email address
   5. website address
9. Are there any changes to your business type?
   Please describe the type of business (one or two words).
11. Are there any changes to the business category?

    1. Yes, please add my business to other categories
    2. Yes, please remove my business from the assigned category
13. Please list the categories you'd like your business ADDED to:
15. Please list the actegories you'd like your business REMOVED from:
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17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field