Directory Request Form

2. Business / Group Name*

4. Contact Name

6. Address*

8. City

9. State

10. Zip Code

12. Link to Map*

    1. Yes

    1. No

    check Yes if you want people to be able to view a map of your location.

14. Phone Number (include dashes)*

15. Fax Number (include dashes)

17. Email Address*

19. Website Address OR Facebook link

    Copy and paste your FULL website address (URL) here. Incomplete URLs will not be added to your listing. Use "copy hyperlink" option.

21. Description

23. Select all applicable categories for your listing from the options below

    1. AC / Heaing
    2. Advertising / Marketing
    3. American
    4. Antiques
    5. Appliance Repair
    6. Asian / Chinese / Japanese
    7. Attorney / Lawyer
    8. Auto Detailing
    9. Auto Insurance
    10. Auto Repair / Parts
    11. Auto Sales / Service
    12. Bank / Financial
    13. Bar / Tavern
    14. BBQ / Sausage
    15. Beauty Shop
    16. Beauty Supplies
    17. Breakfast
    18. Cable / Satellite Service
    19. Car Wash
    20. Catering
    21. Cell Phones
    22. Checking / Savings
    23. Child Care
    24. Church / Religious
    25. Clothing / Apparel
    26. Commercial Lines
    27. Construction
    28. Consignment
    29. Cruises
    30. Daycare

    1. Delivery
    2. Dentist
    3. Dining
    4. Doctor / Physician
    5. Downtown
    6. Electric
    7. Electrical Supplies
    8. Electrician
    9. Electronics
    10. Exercise / Workout
    11. Family Practice
    12. Farm Raised Goods
    13. Farming Supplies
    14. Fast Food
    15. Feed Store
    16. Festivals
    17. Furniture / Appliances
    18. Garden Center / Nursery
    19. Gas
    20. Gas Station
    21. Gifts
    22. Gym / Fitness Center
    23. Gynecologist
    24. Hair Cuts
    25. Hair Care Products
    26. Hardware / Lumber
    27. Horse Breading
    28. Hypnotherapy
    29. Information
    30. insurance

    1. Individual Lines
    2. Interior Design / Decorating
    3. Internet
    4. Italian
    5. Jewelry / Accessories
    6. Legal Services
    7. Life & Business Coach
    8. Liquor / Beer / Wine
    9. Manicures / Pedicures
    10. Massages
    11. Mental Health Counseling
    12. Mexican / Tex-Mex
    13. Mini Mart
    14. Nursing / Rehabilitation
    15. Obstetrician / OBGYN
    16. Oil Changes
    17. Organic
    18. Party Planning
    19. Pediatrician
    20. Pest Control
    21. Pet Care / Grooming
    22. Pizza
    23. Plumbing
    24. Printing / Publishing
    25. Property Management
    26. Re-Sale / Thrift Store
    27. Real Estate
    28. Realtor
    29. Recreation
    30. Recycling

    1. Remodeling / Repairs
    2. Renters Insurance
    3. Repurposed / Treasures
    4. Restaurant
    5. Retail / Shopping
    6. Roofing
    7. Seafood / Fish
    8. Senior Services
    9. Sewer
    10. Shoe Repair
    11. Signs
    12. Storage
    13. Sushi
    14. Telephone
    15. Tires / Tire Repair
    16. Title Company
    17. Tools
    18. Transportation / Bus Service
    19. Trash
    20. Travel / Vacation Planning
    21. TV
    22. Utilities
    23. Venue / Party Rental
    24. Vintage / Retro Items
    25. Veterinary Services
    26. Waste
    27. Water
    28. Weddings
    29. Wireless
    30. Youth Sports

25. You may add categories here if you did not find applicable ones listed above.

    You may add categories here if you did not find applicable ones listed above.

27. Category 1

28. Category 2

30. Category 3

31. Category 4

33. By signing below I give my permission to add this listing to the City of Elgin website. I understand that it is my responsibility to contact the Website Administrator if there are changes to this information.

    By signing below I give my permission to add this listing to the City of Elgin website. I understand that it is my responsibility to contact the Website Administrator if there are changes to this information.

35. Signature*

36. Date*
    Date

38. Please allow 5 business days to have your listing completed. The City of Elgin reserves the right to determine if Listing Requests will be accepted.

Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field