* 1. Your Name

* 2. Your Business

* 3. Your Work Phone:

* 4. Your E-Mail

* 5. Name of Nominee

* 6. Nominee Title

* 7. Nominee Business

* 8. Business Address

* 9. Work Phone

* 10. E-Mail

* 11. Select an Award 

* 12. Names of any other businesses or number of franchises:

* 13. Year main business began:

* 14. Total number of employees:

* 15. Please write any additional comments you may have about your nomination.

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