Eugene Magazine Services Guide Submission Form Survey

1.Please enter your contact information(Required.)

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

2.Would you like the online Enhanced Service Guide membership with a link to your website, that will accompany Eugene Magazine’s e-book for $50/monthly (automatic credit card payment).(Required.)

Yes, I would like the enhanced online Service Guide listing for $50 a month, which will include a photo and my website URL and a listing in the e-book

No, I don't want a membership

I would like more information about the Services Guide Membership.

3.If you answered "Yes" to the previous question, please send a horizontal photo to trisha@eugenemagazine.com

Done

I will do this after I complete this form

4.Business Hours

5.Please categorize your business and the services you provide.(Required.)

6.Please provide a short description of your business.(Required.)

7.Anything else you would like to add?

Current Progress,

0 of 7 answered

Eugene Magazine Services Guide Submission Form

Contribute to Eugene Magazine's online Services Guide