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Directory Request Form

2. 

4. Business / Group Name*

6. Contact Name

8. Address*

10. City

11. State

12. Zip Code

14. Link to Map*

    1. Yes

    1. No

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

16. Phone Number (include dashes)*

17. Fax Number (include dashes)

19. Email Address*

21. 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.

23. Description

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

    1. AC / Heating
    2. Advertising / Marketing
    3. American
    4. Antiques
    5. Appliance Repair
    6. Asian / Chinese / Japanese
    7. Attorney / Lawyer
    8. Auto Insurance
    9. Auto Repair / Parts
    10. Auto Sales / Service
    11. Banners / Signs
    12. Bank / Financial
    13. Bar / Tavern
    14. BBQ / Sausage
    15. Beauty Shop
    16. Cable / Satellite Service
    17. Car Wash
    18. Catering
    19. Cell Phones
    20. Church / Religious
    21. Construction
    22. Counseling
    23. Daycare

    1. Dentist
    2. Doctor / Physician
    3. Downtown
    4. Electric
    5. Electrician
    6. Electronics
    7. Family Practice
    8. Farm Raised Goods
    9. Farming Supplies
    10. Fast Food
    11. Feed Store
    12. Festivals
    13. Furniture / Appliances
    14. Garden Center / Nursery
    15. Gas
    16. Gas Station
    17. Gym / Fitness Center
    18. Hair Cuts
    19. Hardware / Lumber
    20. Horse Breeding
    21. Insurance
    22. Interior Design / Decorating
    23. Internet

    1. Italian
    2. Jewelry / Accessories
    3. Legal Services
    4. Liquor / Beer / Wine
    5. Manicures / Pedicures
    6. Massages
    7. Mexican / Tex-Mex
    8. Nursing / Rehabilitation
    9. Obstetrician / OBGYN
    10. Oil Changes
    11. Organic
    12. Pediatrician
    13. Pest Control
    14. Pet Care / Grooming
    15. Pizza
    16. Plumbing
    17. Printing / Publishing
    18. Property Management
    19. Re-Sale / Thrift Store
    20. Real Estate
    21. Realtor
    22. Recycling
    23. Restaurant

    1. Retail / Shopping
    2. Roofing
    3. Seafood / Fish
    4. Senior Services
    5. Sewer
    6. Shoe Repair
    7. Storage
    8. Sushi
    9. Tires / Tire Repair
    10. Title Company
    11. Transportation / Bus Service
    12. Trash
    13. Travel / Vacation Planning
    14. TV
    15. Utilities
    16. Venue / Party Rental
    17. Vintage / Retro Items
    18. Veterinary Services
    19. Waste
    20. Water
    21. Weddings
    22. Youth Sports
    23. Yoga / Exercise

27. 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.

29. Category 1

30. Category 2

32. Category 3

33. Category 4

35. 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.

37. Signature*

38. Date*
    Date

40. 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:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field