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* 1. Your Business Name, as you'd like it listed: 

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* 2. Phone Number: 

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* 3. Contact Name (will not be published) 

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* 4. Email Address (will not be published) 

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* 5. Business Website

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* 6. Physical Address:

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* 7. Brief Description of your Business (8-10 words)

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* 8. Do you currently accept Middlebury Money (a local currency bank check by National Bank of Middlebury that can be deposited at any financial institution)

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* 9. Would you like to participate in the town-wide "Midd Money Match" local shopping rewards program?

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