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2. Business Name*
4. Address*
6. Is your business currently open?*

   1. Yes
   2. No
8. If your business has not reopened yet, is there a date set for reopening? *

   1. Yes
   2. No
10. If yes, what is the planned date of reopening?
    If yes, what is the planned date of reopening?
12. What type of services will you provide until your business completely re-opens?
14. Do you offer curbside delivery? *

    1. Yes
    2. No
16. Do you deliver to customers? *

    1. Yes
    2. No
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18. 1. Receive an email copy of this form.
19. Email address

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20. Submit

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